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ȣ - 490357 58 |
| The Difference of diastolic filling during exercise in early hypertension heart |
| Ajou University School of Medicine, Suwon, Korea |
| Jung –Hyun Choi, Soo-Jin Kang, Hae-Sun Lee, Hong-Seok Lim, Byoung-Joo Choi, So –Yeon Choi, Myeong-Ho Yoon, Gyo-Seung Hwang, Seung-Jae Tahk, Joon-Han Shin |
Background; Several studies suggested that stroke volume, during exercise, is reduced in patients with more severe and long standing hypertension. This may be explained by the combined effect of impaired diastolic relaxation in hypertensive subjects and blunted augmentation of LV ejection fraction due to abnormal diastolic filling during exercise. We sought to examine the diastolic relaxation and diastolic filling during exercise in early hypertensive heart.
Methods; Supine bicycle exercise was done in 45 hypertensive patients (Group A; age 46±13 years, 31 men) with LV hypertrophy and normal systolic function and 33 normal controls (Group B; age 40±11 years, 25men). At baseline and each stage of exercise, Doppler echocardiographic measurement of E and A, E' was performed. ΔE was defined as the % change of E velocity from baseline to early stage exercise (25W) and ΔEp was defined as % change of E velocity from early stage to peak exercise.
Results; At baseline, group A showed any significant difference compared with group B; E velocity (74±17 vs 78±15 cm/s) and E/A ratio (1.2±0.4 vs 1.4±0.3), E’velocity (11±3 vs 14±3 cm/s) and E/E’ratio (6.8±2.3 vs 5.8±1.6) and IVRT (108±22 vs 105±18 ms) compared with group B (p=NS, each). With early stage exercise (25W), E velocity was increased from 74±17 to 110±24 cm/s in group A and from 78±15 to 107±21 cm/s in group B. △E was higher in group A (54±34 % vs 39±25 %, p=0.07). There was no significant change of E/E’ ratio in both groups due to concomitant increase of E’velocity during exercise. Subgroup analysis as initial diastolic dysfunction in group A revealed difference of ΔE; The group A1 that showed initial abnormal diastolic function had much higher ΔE (66±32% vs 39±30%, p=0.04) than group A2 with initial normal diastolic function. At peak exercise, ΔEp were same in all goups; group A1 100±62%, group A2 73±30%, group B 82±30% (p<0.05,each).
Conclusion; In early hypertensive heart with diastolic dysfunction, Doppler echocardiographic evaluation for the characteristic change of LV filling pattern during exercise showed remarkable increment of E velocity at early stage of exercise (higher ΔE).
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