To Assess Left Ventricular Diastolic Function In Essential Hypertension With Different LV Geometry Using Quantitative Tissue Velocity Imaging

To approach the correlation between the patterns of geometricremodeling of left ventricle (LV) and the left ventriculardiastolic function in essential hypertension (EH) by Quantitativetissue velocity imaging(QTVI). To assess LV whole and regionaldiastolic function in EH with different geometry and to reflect theabnormality of wall motion.109 EH patients and 26 normal subjects were studied with routinetwo-dimensional and flow spectrum Doppler echocardiogram and weremeasured some parameters (LAD, LVDed, E/A, et al) and with colortissue Doppler imaging of the 4 sides of the apical 2-chamberview( inferior, anterior),apical 4-chamber view( posterior septum,lateral)and cardiac apex long axis view(anterior septum,posterior). We analysis each wave velocities (isovolumetricrelaxation-VIR, rapid filling–Ve, atrial contraction-Va) andisovolumetric relaxation time interval(IVRT). According to theGanau's classification hypertensive patients were counted LVMIand RWT then were classified into four groups: normal geometry(A):14 cases had normal LVMI and RWT;concentric remodeling (B):38cases had higher RWT and normal LVMI;concentric hypertrophy (C):45cases had both larger LVMI and RWT;eccentric hypertrophy (D):12cases had higher LVMI and normal RWT. Then each group was comparedwith the control group (N) respectively. Every parameter wasanalyzed by one-way analysis of variance (ANOVA) with statisticalsoftware SPSS11.5.Results showed that: 1.The parameters of two-dimensional andflow spectrum Doppler echocardiogram : LAD in every EH group werelarger than group N (P ﹤0.05)and consecutive augmented from groupB to D. The flow spectrum of mitral valve had this phenomenon:Compared with group N, groups B and C had lower E and higher A. E/A<1was in groups B and C, in contrast groups A and D showed E/A>1. 2.The indexes of QTVI: ①IVRT lengthened obviously in B,C and D groups.②Normal subjects displayed brief and low positive VIR only in fewsegments(51/312).Yet this abnormal positive VIR present itself inpercentage 64(837/1308) in EH.IN groups B and C and the majorityof segments of group A the VIR were over and above which in controlgroup. ③ The tissue Doppler imaging of basal level had thisphenomenon: Ve in every EH group excluded group A in anterior basalsegment, were lower than group N(P ﹤0.05), dissociative wallhigher than ventricular septum. Va in posterior septum of group Aand interior of group B were higher than control group. Va in groupD lower than in groups A and B, especially in ventricular septumand lateral wall. Ve/Va in dissociative walls had no distinguishamong groups. Ve/Va<1 appeared in posterior septum,interior andposterior wall of EH groups B and C, distinctly compared with groupN(P ﹤0.05). Group A had Ve/Va>1 and group D had Ve/Va>2.Analysed every parameter synthetically, the LV diastolicfunction decreased in EH patients despite of ventricular geometry.1.Normal geometry: LAD augmented;Ve of basal segment diminished;abnormal positive VIR presented itself;Ve/Va>1 and E/A>1.EH withnormal geometry had normal LV whole diastolic function and normalfilling, but had heterogeneity and asynchrony of regional cardiacwall motion. The LV regional diastolic function is likely todecrease.2. Concentric remodeling: LAD resembled group A, were larger thancontrol group;Ve of basal segment more diminished;Va of basalsegment augmented;IVRT lengthened;abnormal positive VIR presenteditself;in dissociative walls Ve/Va>1 and in non-dissociativewalls Ve/Va<1;E/A<1. EH with concentric remodeling had impairedrelaxation .3. Concentric hypertrophy: LAD more augmented;Ve of basal segmentmore diminished;Va of basal segment no augmented;IVRT morelengthened;abnormal positive VIR presented itself;in dissociativewalls Ve/Va>1 and in non-dissociative walls Ve/Va<1;E/A<1. EHwith concentric hypertrophy had evident heterogeneity andasynchrony of regional motion and impaired relaxation, could showedpseudonormal filling.4. Eccentric hypertrophy: LAD most augmented;in basal segment Veand Va diminished;IVRT more lengthened;abnormal positive VIR hadno obviously;Ve/Va>2 and E/A>1. EH with eccentric hypertrophyimpaired diastolic function badly, could showed pseudonormalfilling or restriction.QTVI can detect abnormal diastolic function in which had the normalflow spectrum of mitral valve and can also detect movement, anomalyof partial ventricular in the isovolumetric relaxation intervalmore sensitively than the Doppler spectrum analysis.