Background: Heart has a various response about volume loading status. Also diastolic functional reserve(difference of mitral annular velocity) is various in patients with hypertension. We hypothesized that when the volume loading status by leg elevation during 3 min. diastolic functional reserve will have a various response and relation with stroke volume(SV) augmentation.
Method and Result: From August 2009 to July 2010, 230 patients were referred to our Echo lab. for evaluation of HTN. Almost patients were performed Comprehensive echocardiographic evaluation of systolic and diastolic function was performed at rest and leg elevation status during 3minites and Laboratory test, ECG, ABI and PWV test, 24 hours ambulatory BP monitoring, 230 patients were classified into 2 groups: Group 1(n=42) had decreased or no change difference of average septal and lateral mitral annular velocity after leg elevation test. Group 2(n=188) had increased difference of average septal and lateral mitral annular velocity after leg elevation test. There were no significant differences of Age, Sex, BSA, Ejection fraction, LVEDD, LVESD, LAVI, mitral E, A, DT at base and after leg elevation, SBP/DBP at rest and after leg elevation, HR at base, Mitral tissue velocity at septal, lateral, average of E’, E/E’and E/E’average at base, and PWV. Also there were no significant differences of delta SV(difference of SV at base and after leg elevation), delta CO in between 2 groups. HR after leg elevation is significantly lower in Group 1.(64.17±11.00 vs 67.86±10.70, p=0.045) Septal E’, lateral E’ and average of septal and lateral E’ after leg elevation were significantly lower in Group1(5.78±2.33 vs 6.62±2.20, p=0.029; 7.76±2.63 vs 9.47±2.80, p<0.001; 6.77±2.38 vs 8.04±2.38, p=0.002, respectively). E/E’septal, E/E’lateral, E/E’average after leg elevation were significantly higher in group1(13.48±5.63 vs 11.16±3.83, p=0.014; 9.79±3.85 vs 7.67±2.50, p=0.001; 11.23±4.46 vs 9.00±2.80, p=0.003, respectively). Increased SV Case significantly frequent in Group 2(p= 0.016). Also Increased SV case significantly frequent in delta septal E’group(p=0.020) but not frequent in delta lateral E’group(p=0.266)
Conclusion: among the patients with hypertension, Increased stroke volume case more frequent in good diastolic functional reserve (increased difference of E’ average). Our Study suggest that difference of average of E’ effects on stroke volume at volume loading condition. In this point, difference of septal E’ consider as important factor influenced stroke volume in patients with hypertension. CO;cardiac output,delta E’; difference of E’at rest & after leg elevation, E’ave; average E’at septal and lateral
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