Left ventricular structural and functional characteristics in Cushing's syndrome

OBJECTIVES: This study was designed to evaluate left ventricular (LV) anatomy and function in patients with Cushing's syndrome. BACKGROUND: A high prevalence of LV hypertrophy and concentric remodeling has been reported in Cushing's syndrome, although no data have been reported on LV systolic and diastolic function. METHODS: Forty-two consecutive patients with Cushing's syndrome and 42 control subjects, matched for age, gender, and blood pressure, were studied. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured by echocardiography, endocardial and midwall fractional shortening (FS) were assessed, and diastolic filling was measured by Doppler transmitral flow. RESULTS: The RWT was significantly greater in Cushing patients than in controls. Left ventricular hypertrophy and concentric remodeling were observed in 10 and 26 patients with Cushing's syndrome, respectively. In Cushing patients, midwall FS was significantly reduced compared with controls (16.2 +/- 3% vs. 21 +/- 4.5%, p = 0.01). The ratio of transmitral E and A flow velocities was reduced and E deceleration time was prolonged in Cushing patients compared with controls (p = 0.03 and p < 0.001, respectively). CONCLUSIONS: In patients with Cushing's syndrome, cardiac structural changes are associated with reduced midwall systolic performance and with diastolic dysfunction that may contribute to the high risk of cardiovascular events observed in these patients.     

高血压左室构型与左室中层力学的关系

目的：用室壁应力－左室中层缩短率关系做为评价心肌收缩性的指标,研究高血压不同左室构患者心肌收缩性的改变与心功能变化的关系。方法：应用超声心动图计算左室重量指数（ＬＶＭＩ）和相对室壁厚度（ＲＷＴ）,按ＬＶＭＩ和ＲＷＴ将左心室分为四种构型。对１１７例原发性高血压病人和４５例健康人左心室结构按左室室壁应力（ＭＥＳＳ）和室壁中层缩短率（ｍＦＳ）来估计心功能情况。结果：以射血分数、左室短轴缩短率和左室中层缩短率表示的收缩功能离心性肥厚受损严重,以室壁应力－左室中层缩短率关系表示的心肌收缩性,向心性肥厚最重。以ＥＦ斜率等表示的心脏舒张功能高血压不同左室构型患者损害不同,舒张功能的改变与心肌收缩必的损害成正相关。结论：高血压不同左室构型患者心肌收缩性损害不同,左室构型向向心性发展在一定阶段上代偿了心肌收缩性的下降,以保持心脏     

Left ventricular hypertrophy differences in male professional runners and in young patients suffering from mild hypertension

AIMS: This study was executed to evaluate left ventricular (LV) geometry, diastolic and systolic function assessed by B- and M-mode and pulsed Doppler echocardiography in a group of professional sprinter runners (group I), in young patients suffering from mild hypertension (group II) and in control young adults (group III). Twenty-one male sprinter runners were checked during a period of training and compared with 19 young patients suffering from mild hypertension and 15 healthy controls matched for gender and body size. FINDINGS: LV septum thickness, LV posterior wall thickness, LV ejection fraction, LV shortening fraction, midwall fractional shortening and stroke volume were significantly higher in runners compared to hypertensive patients and controls (p < 0.001). A significant increase of diastolic function parameters of the early peak flow velocity, E, and the early/late diastolic wave ratio, E/A, and in the isovolumic relaxation time or in the E velocity deceleration time wave was observed in hypertensive patients when compared to runners and controls (p < 0.05). The study of the pulmonary venous flow revealed a significant increase in the early systolic flow velocity, S, in hypertensive patients compared to runners (p < 0.05); the late diastolic flow velocity, D, appeared to be similar in all groups, while atrial backward flow velocity, Ar, was higher in group I and II respect to control (p < 0.001). CONCLUSIONS: Our data indicate that LV concentric hypertrophy in sportsmen is associated with improvement of systolic and diastolic performance, whereas diastolic dysfunction can occurs even in the early stages of hypertension in young patients, in whom an alteration in the LV filling appears even in absence of systolic dysfunction and evident concentric myocardial hypertrophy.     

早期原发性高血压左心室舒张功能的超声心动图评价

目的:应用脉冲组织多普勒成像技术评价早期原发性高血压不伴左心室肥厚患者的左心室舒张功能,并探讨其临床意义。方法:用组织多普勒成像技术检测66例早期不伴左心室肥厚的单纯原发性高血压患者(高血压组)及50例健康人(正常对照组)二尖瓣环4个位点(左心室基底部间隔、侧壁、前壁及下壁)的舒张早期平均运动峰值速度(Emav)、舒张晚期平均运动峰值速度(Amav)及Emav/Amav值,并与常规超声心动图指标等进行相关性分析。结果:高血压组的左心室重量指数和左心室相对室壁厚度均高于正常对照组(P<0.01,P<0.001);左心室等容舒张时间及E峰减速时间均大于正常对照组(P<0.05,P<0.01);Emav、Emav/Amav值均明显低于正常对照组(P均<0.001),而两组间的Amav值无显著性差异(P=0.26);高血压组二尖瓣血流E峰与二尖瓣环Emav的比值(E/Emav)大于正常对照组(P<0.01)。高血压组单变量相关分析显示:Emav/Amav值与等容舒张时间、E峰减速时间均呈负相关(r=-0.306,P<0.05;r=-0.392,P<0.01),与E/Emav无明显相关性。多变量统计分析显示:组织多普勒检测的Emav/Amav值与年龄(P<0.001)、左心室相对室壁厚度(P<0.05)密切相关,而常规多普勒血流检测E/A值只与年龄相关(P<0.01)。结论:原发性高血压早期在左心室肥厚之前左心室舒张功能可出现左心室松驰性降低而顺应性无明显损害,左心室充盈压可能升高;应用组织多普勒成像技术检测的早期原发性高血压患者的左心室舒张功能异常伴随着早期左心室向心性重构的发展。     

尿毒症维持性血液透析患者左心室构型和功能的超声心动图研究

目的 评价尿毒症维持性血液透析患者的左心室形态学及舒张、收缩功能.方法 入选尿毒症维持性血液透析患者40例(尿毒症组),正常人45例(对照组).应用常规超声心动图、组织多普勒、实时三维超声心动图的多项指标对比分析尿毒症组左心室形态学改变、左心室重构类型;分析左心窒舒张和收缩功能变化,并对舒张功能异常进行分级;评价左心窜收缩及舒张的同步性.结果 尿毒症组的室壁厚度、左心室质量指数、左心室质量/容积比值显著性高于对照组(P<0.01),左心室构型以向心型肥厚为主(占50.0%),其次为向心型重构和偏心型肥厚(各占17.5%).尿毒症组的各项舒张功能指标与对照组差异有统计学意义(P<0.05),舒张功能异常以松弛功能受损类型居多(占85.0%),其中38.2%伴有左心室充盈压升高.尿毒症组的左心室射血分数、每搏量与对照组差异无统计学意义,但组织多普勒二尖瓣环收缩期运动速度显著低于对照组(P<0.05).左心室收缩不同步指标两组差异无统计学意义,舒张不同步指标尿毒症组显著高于对照组(P<0.05).结论 左心室肥厚、心肌质量增加和左心室舒张功能异常是尿毒症维持性血透患者心肌损害最突出的特征,舒张功能异常的出现早于收缩功能异常.     

Spatial and temporal analysis of left ventricular filling flow propagation in hypertensive patients before and after regression of myocardial hypertrophy with alacepril therapy

The purpose of this study was to assess the clinical significance of spatial and temporal analysis of left ventricular (LV) filling-flow propagation using color M-mode Doppler echocardiography before and after regression of LV hypertrophy in patients with hypertension. Seven patients with hypertensive LV hypertrophy were studied. Echocardiographic and Doppler examinations were performed both before and after 6 months administration of alacepril. LV mass index (LVMI), LV flow propagation velocity (FPV), and the maximal early transmitral flow velocity (E) were measured. LVMI, FPV, and FPV/E ratio were compared to before and after administration of alacepril. In addition, the correlation between LVMI and FPV/E ratio was evaluated. Results showed that LVMI was significantly decreased (P < 0.05) and the FPV/E ratio was significantly increased (P < 0.05) after treatment with alacepril. There was no significant change in FPV. In addition, there was a significant negative correlation between LVMI and the FPV/E ratio (r = -0.662, P < 0.001). The present study indicates that the FPV/E ratio could be a useful noninvasive parameter to assess the diastolic dysfunction associated with LV hypertrophy in patients with hypertension.     

Are left ventricular mass,geometry and function related to vascular changes and/or insulin resistance in long-standing hypertension? ICARUS: a LIFE substudy

Vascular hypertrophy and insulin resistance have been associated with abnormal left ventricular (LV) geometry in population studies. We wanted to investigate the influence of vascular hypertrophy and insulin resistance on LV hypertrophy and its function in patients with hypertension. In 89 patients with essential hypertension and electrocardiographic LV hypertrophy, we measured blood pressure; insulin sensitivity by hyperinsulinaemic euglucaemic clamp; minimal forearm vascular resistance (MFVR) by plethysmography; intima-media cross-sectional area of the common carotid arteries (IMA) by ultrasound; and LV mass, relative wall thickness (RWT), systolic function and diastolic filling by echocardiography after two weeks of placebo treatment. LV mass index correlated to IMA/height (r=0.36, P=0.001), serum insulin (r=-0.25, P<0.05), plasma glucose (r=-0.34, P<0.01), and showed a tendency towards a correlation to insulin sensitivity (r=0.21, P=0.051), but was unrelated to MFVR. Deceleration time of early diastolic transmitral flow positively correlated to IMA/height (r=0.30, P<0.01). The ratio between early and atrial LV filling peak flow velocity negatively correlated to MFVR(men) (r=-0.30, P<0.05). Endocardial and midwall systolic LV function were not related to vascular hypertrophy, plasma glucose, serum insulin or insulin sensitivity. In conclusion, insulin resistance was not related to LV hypertrophy or reduced LV function. However, high thickness of the common carotid arteries was associated with LV hypertrophy and high deceleration time of early diastolic transmitral flow. High MFVR was associated with low ratio between early and atrial LV filling peak flow velocity. This may suggest that systemic vascular hypertrophy contributes to abnormal diastolic LV relaxation in patients with hypertension and electrocardiographic LV hypertrophy.     

高血压病患者左室肥厚及构型改变与胰岛素抵抗的关系

目的:探讨高血压病(EH)患者胰岛素抵抗(IR)对左心室肥厚(LVH)和几何构型的影响。方法:检测124 例EH病人的左室重量指数(LVMI),相对室壁厚度(RWT),空腹血清葡萄糖(FSG)、空腹血胰岛素(FSI)浓度, 并计算胰岛素敏感性指数(ISI)。依照LVMI及RWT的数值124例EH病人被分为左室正常构型(51例),向心性构型(30例),向心性肥厚型(22例),离心性肥厚型(21例)。结果:RWT与年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、平均心率呈正相关(r=0.16-0.22,P<0.05),与ISI呈负相关(r=-0.24),LVMI与SBP、DBP呈正相关(r=0.16-0.20,P<0.05),与ISI不相关。向心性重构组和向心性肥厚组年龄、RWT、HR、BMI大于正常构型组(P<0.05-<0.01),而ISI小于正常构型组(P<0.01)。结论:胰岛素敏感性降低与EH患者左心室肥厚无关,与RWT增加密切相关;ISI可能是EH患者发生左室向心性构型的重要影响因素之一。     

老年糖尿病患者心脏病变特点及相关危险因素分析

目的 探讨老年糖尿病患者心脏病变的相关危险因素.方法 住院的糖尿病患者274例,根据年龄分为A组(<60岁,94例)和B组(≥60岁,180岁).记录两组患者的身高、体重、血糖、血脂、血压、病程、射血分数(EF)、左心室缩短分数(FS)、舒张末期左室内径、舒张末期室间隔厚度和左室后壁厚度,计算左室质量指数(LVMI)和相对室壁厚度(RWT)及超敏C反应蛋白(hs-CRP)和肿瘤坏死因子-α(TNF-α).多元线性回归分析年龄与各阳性指标之间的相关性.结果 两组身高、体重、空腹血糖、血脂、血压、EF和FS无显著差异;B组LVMI、RWT、超敏C反应蛋白和TNF-α均较A组明显增高(P<0.05);多元线性回归分析提示年龄、病程、超敏C反应蛋白、TNF-α与糖尿病患者RWT、LVMI密切相关.结论 超敏C反应蛋白和TNF-α可有效的在早期预警糖尿病心脏病变的病理改变过程.     

Effects of spironolactone during an angiotensin II receptor blocker treatment on the left ventricular mass reduction in hypertensive patients with concentric left ventricular hypertrophy.

BACKGROUND: Angiotensin II receptor blockers (ARB) are now commonly used to treat hypertension because of their beneficial effects on cardiovascular remodeling. However, ARB treatment can not inhibit the left ventricular (LV) remodeling sufficiently, which may be related with aldosterone secretion. To inhibit the action of aldosterone during ARB treatment, the additional effects of an aldosterone blocker and spironolactone (SPRL) on LV hypertrophy in patients with essential hypertension was studied. METHODS AND RESULTS: The patients with essential hypertension were randomly divided into 2 groups; 1 group was treated with an ARB, candesartan (8 mg/day), for 1 year (ARB group) and other group was treated with the ARB for the first 6 months and with the ARB plus SPRL (25 mg/day) for the next 6 months (combination group). Seventy patients who underwent echocardiography every 6 months were analyzed and were also classified into 4 subgroups of LV geometric pattern according to the LV mass index (LVMI) and the relative wall thickness (RWT). The ARB treatment and the addition of SPRL significantly reduced the blood pressure, however, both treatments did not affect the LV geometry in both groups. The ARB treatment in the subgroups of concentric LV remodeling (RWT>or=0.45 and LVMI<125) and concentric LV hypertrophy (RWT>or=0.45 and LVMI>or=125) significantly reduced RWT. However, ARB treatment in all subgroups did not affect LVMI. The addition of SPRL only in the concentric LV hypertrophy subgroup significantly reduced the LVMI, despite similar changes in blood pressure. CONCLUSIONS: These results indicated that the addition of SPRL treatment during the ARB treatment and conventional treatments is clinically useful to reduce the LVMI in hypertensive patients with concentric LV hypertrophy; however, does not improve the eccentric LV hypertrophy.     

Pioglitazone improves left ventricular diastolic function in patients with essential hypertension

BACKGROUND: Left ventricular (LV) hypertrophy and diastolic dysfunction, which are common cardiac consequences of hypertension, are modified by insulin resistance. The present study assessed the hypothesis that primary treatment of insulin resistance may reverse such cardiac changes in hypertensive patients. METHODS: A total of 30 patients with essential hypertension were enrolled in this study. In echocardiographic examinations, LV mass index, the peak velocity ratio of early diastolic to atrial filling (E/A), and the E-wave deceleration time (DcT) were determined. Insulin sensitivity test with steady-state plasma glucose (SSPG) method, oral glucose tolerance test, and blood samplings for measurement of adiponectin and matrix metalloproteinase (MMP)-2 were also performed. Six months after treatment with pioglitazone (30 mg/day), an insulin sensitizer, these examinations were repeated. RESULTS: Pioglitazone significantly increased E/A and decreased DcT, without a change in LV mass index. These improvements in diastolic properties were much greater in subjects with a marked (>or==3.3 mmol/L) decrease in SSPG (n=11) than the others (n=19), although the decrease in glucose levels did not differ between the two groups. In addition, the changes in E/A and DcT were closely correlated with the decrease in SSPG. Pioglitazone treatment significantly elevated plasma adiponectin and MMP-2 levels, and the increase in MMP-2 was positively correlated with the increase in adiponectin. CONCLUSIONS: The present findings demonstrate that pioglitazone improves LV diastolic function without LV mass regression in hypertensive patients in proportion to the amelioration of insulin resistance. These findings suggest that increased adiponectin and MMP may be involved in the beneficial effect of pioglitazone on diastolic function.     

Transmitral E/A ratio decreases in association with abdominal fat accumulation in patients with impaired glucose tolerance or mild diabetes without left ventricular hypertrophy

An abnormal left ventricular (LV) diastolic function is an early sign of diabetic cardiomyopathy, which is characterized by an impaired diastolic and/or systolic function of the left ventricle in the absence of ischemic, valvular, or hypertensive heart disease, and serves as a marker of cardiovascular risk. However, it is unclear whether LV diastolic abnormalities can be detected in patients with impaired glucose tolerance (IGT) or mild diabetes without LV hypertrophy (LVH). We examined echocardiographic data from 92 consecutive Japanese patients aged 45–79 years with or without IGT or mild diabetes in the absence of LVH. Impaired glucose tolerance or mild diabetes was defined as the presence of one or more of the following criteria: fasting plasma glucose >110 mg/dl, hemoglobin A1c >5.6%, homeostasis model assessment ratio >1.73, or the taking of oral antihyperglycemic drugs. Left ventricular hypertrophy was defined as an LV mass index (LVMI) >116 g/m² in men and >104 g/m² in women. Patients with ischemic, valvular, or hypertensive heart disease were excluded. The age, blood pressure, heart rate, and LVMI were similar between patients with (IGT/DM group, n = 43) and without IGT or mild diabetes (non-IGT/DM group, n = 49), whereas the body mass index and waist circumference (WC) were greater in the IGT/DM compared to the non-IGT/DM group (P < 0.05 and P < 0.001, respectively). The transmitral E/A ratio was lower and the deceleration time longer in the IGT/DM than in the non-IGT/DM group (both P < 0.05). Stepwise regression analysis revealed that age and WC were independent determinants of the E/A ratio. In conclusion, diastolic abnormalities without LVH can be detected in Japanese patients with IGT or mild diabetes. The E/A ratio decreases in association with abdominal fat accumulation.     

A new parameter of pulsed-wave tissue Doppler imaging: IVRa

Objective: We investigated how velocity of isovolumetric relaxation period on pulsed‐wave tissue Doppler trace (IVRa and IVRb) is affected by the left ventricular (LV) geometry changes. Methods: Two hundred cases without exclusion criteria were included in the study. Normal LV mass index (LVMI) and normal relative wall thickness (RWT) was assigned to group 1 (n = 72). Concentric remodeling (normal LVMI and increased RWT) was defined to group 2 (n = 25). Eccentric LV hypertrophy (LVH) (increased LVMI and normal RWT) was defined to group 3 (n = 62). And finally, concentric LVH (increased LVMI and increased RWT) was defined to group 4 (n = 41). Results: Patients with LVH (groups 3 and 4) were older than group 1 (P = 0.017 and 0.001). It was observed in the assessment of M‐mode ECHO parameters that the aortic valve diameter, aortic valve opening, LV end‐systolic diameter (LVESD), LV end‐diastolic diameter (LVEDD), and left atrium (LA) were higher in cases with eccentric LVH. It was shown that Ea velocity and Sa velocity time integral (Sa‐VTI) were decreased with LV geometry change. However, IVRa velocity and E/Ea were increased as LV geometry change. A positive correlation between IVRa velocity and LVMI (correlation ratio = 34%, P = 0.000) was found. Similarly, a positive correlation between IVRa velocity and RWT (correlation ratio = 17%, P = 0.025) was found. Conclusion: IVRa velocity exhibits a positive correlation with LV geometry changes indicating that IVRa velocity is affected by LV geometry like the other parameters influenced by LV geometry.     

The relation between left ventricular geometric patterns and left ventricular midwall mechanics in hypertensive patients.

To evaluate the alteration of myocardial contractility in hypertensive patients with different left ventricular geometric patterns by the end-systolic stress-midwall fractional shortening relation. Echocardiography was applied to study the left ventricular geometry and cardiac function among 117 cases of essential hypertension, with 45 normal cases as control(s). Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated using echocardiographic data. All patients were divided into four kinds of left ventricular geometry pattern based on LVMI and RWT. Patients of the eccentric hypertrophy group suffered the most serious damage of left ventricular systolic function. Myocardial contractility shown by end-systolic stress-midwall fractional shortening relation was significantly decreased in the concentric remodeling group, eccentric hypertrophy group and concentric hypertrophy group, and those with concentric hypertrophy showed the worst contractility. The degree of myocardial contractility damage was different in patients with different left ventricular geometric patterns. Geometric changes may have compensated for the reduction of myocardial contractility in some phases in order to maintain the normal pump function.     

Relation of plasma brain and atrial natriuretic peptides to left ventricular geometric patterns in essential hypertension

We investigated whether plasma brain and atrial natriuretic peptide (BNP and ANP, respectively) levels could reflect left ventricular (LV) geometry and function in patients with mild to moderate essential hypertension. A positive correlation was found between LV mass index (LVMI) and plasma ANP levels in 84 untreated, hypertensive patients, but not between LVMI and plasma BNP levels. As compared with other geometric patterns, plasma BNP levels were increased in concentric hypertrophy, in which LVMI was increased and LV diastolic function was decreased. These data suggest that production of BNP was increased in hypertensive patients with concentric hypertrophy via LV overload or depression of diastolic function.     

Impact of diastolic Doppler indices on exercise capacity in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy)

OBJECTIVE : To assess whether Doppler evidence of impaired early diastolic relaxation during exercise is associated with lesser exercise capacity in hypertensive patients. DESIGN : Single center addition to the echocardiographic substudy in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. SETTING : University hospital out-patient clinic. METHODS: A total of 60 patients (29 women and 31 men) with essential hypertension and electrocardiographic LV hypertrophy. INTERVENTIONS : Assessment of Doppler echocardiography and ergospirometry during semi-upright bicycling. MAIN OUTCOME MEASURE : Exercise capacity and its relation to diastolic Doppler indices at rest and during exercise. RESULTS : Average resting blood pressure was 181/97 +/- 18/9 mmHg, LV mass/body surface area 127 +/- 26 g/m2, midwall shortening 16 +/- 2%, and isovolumic relaxation time (IVRT) and transmitral early to atrial filling velocity (E/A) ratio 121 ms and 0.80, respectively. Exercise capacity, assessed as peak oxygen uptake and exercise load at exhaustion in all patients, were 20 and 25% higher, respectively, in men than women (both P < 0.01). In multivariate analysis, higher peak exercise load was related to male gender, higher E/A ratio at rest, greater reduction in IVRT during exercise and higher peak exercise heart rate (multiple R2 = 0.59, P < 0.01). Younger age, greater reduction in IVRT during exercise, higher midwall shortening and peak exercise heart rate were associated with higher peak oxygen uptake (multiple R2 = 0.47, P < 0.01). CONCLUSION : Diastolic LV performance significantly influences exercise capacity in hypertensive patients with LV hypertrophy. Impaired exercise capacity is more strongly associated with blunted reduction in IVRT during exercise than with lower E/A ratio at rest.     

Predictors of congestive heart failure in patients on maintenance hemodialysis.

BACKGROUND: Cardiovascular disease is a major cause of death in patients on maintenance hemodialysis (HD). Predictors of congestive heart failure (CHF) events in patients on HD were investigated, focusing on left ventricular (LV) function. METHODS AND RESULTS: One hundred consecutive patients on HD were followed for at least 5 years after index examination performed 1 day after the last HD session. Tests included M-mode and Doppler echocardiography and plasma brain natriuretic peptide (BNP) and hemoglobin (Hb) concentration measurements. Patients with atrial fibrillation or poor echocardiographic images were excluded. Confounding factors included diabetes mellitus (DM), hypertension, age, HD duration, LV fractional shortening, E/A of transmitral flow velocity pattern, Tei index, LV mass index (LVMI), BNP level, Hb, and use of antihypertensive or antiarrhythmic drugs. Six CHF events occurred during 1,703+/-565 days. DM and Hb <10 g/dl were identified as independent predictors of CHF events in a stepwise Cox regression model after DM, LVMI, BNP, and Hb <10 g/dl were selected in the univariate analysis. The hazard ratio (confidence interval) was 10.96 (1.49-80.44) for DM, and 23.00 (2.41-219.76) for Hb <10 g/dl. The estimated hazard across time was constant (T_COV*DM; p=0.726, T_COV*Hb <10 g/dl; p=0.681) by time-dependent covariates analysis. CONCLUSION: In patients on maintenance HD, DM and anemia (Hb <10 g/dl), but not echo-derived cardiac function, predicted CHF events.     

Assessment of diastolic function in elderly patients with aortic stenosis. Evaluation of flow propagation velocity using color M-mode Doppler technique

Background:   The purpose of this study was to assess the left ventricular (LV) diastolic function in elderly patients with aortic stenosis (AS).
Methods:   The subjects included 11 consecutive elderly patients with AS (AS group), and 17 elderly patients with hypertensive LV hypertrophy (HT group), all were more than 70 years of age. Echocardiographic and Doppler examinations were performed, and the data was analyzed to determine the LV end-diastolic dimension (LVDd), the LV mass index (LVMI), fractional fiber shortening (FS), the aortic valve resistance (AVR), peak aortic flow velocity (peak V), and the maximal early diastolic transmitral flow velocity (E). The flow propagation velocity (FPV) was measured during early LV filling phase using a color M-mode Doppler method. Then, (i) FPV/E were compared between the two groups; and (ii) correlations between FPV/E and LVMI, LVDd, AVR, and FS/peak V were assessed in the AS group.
Results:   FPV/E was significantly lower in the AS group than in the HT group ( P  < 0.01). There were significant negative correlations between FPV/E and LVMI ( r  =−0.728, P  < 0.001), and FPV/E and LVDd ( r  =−0.642, P  < 0.01) in the AS group. There were no significant correlations between FPV/E and AVR, and FPV/E and FS/peak V.
Conclusion:   We considered that in elderly patients with AS, diastolic dysfunction was more severe than that of hypertensive heart disease even if the LV hypertrophy is equivalent, and diastolic dysfunction was more severe in cases having a larger LVDd and a larger LVMI, and could not be related to hemodynamic severity of AS.     

Influence of plasma aldosterone on left ventricular geometry and diastolic function in treated essential hypertension.

Since aldosterone is known to promote interstitial fibrosis in cardiac tissues, it is possible that aldosterone may influence cardiac structure and function. In the present study, we investigated whether plasma aldosterone concentration (PAC) is related to the distinct patterns of left ventricular (LV) geometry and LV diastolic function in treated essential hypertension. In 92 patients with chronically treated essential hypertension, two-dimensional and Doppler echocardiographic examinations were performed and LV inflow velocities were measured for evaluation of LV diastolic function. When patients were divided into four groups by the different LV geometric patterns, PAC in patients with eccentric hypertrophy was significantly higher than in those with concentric hypertrophy (15.2+/-2.1 vs. 10.0+/-0.7 ng/dl, p<0.01). However, the ratio of the peak velocity of early diastolic filling to that of atrial filling (EIA), an index of LV diastolic function, was significantly decreased in patients with concentric hypertrophy compared with those showing normal geometry. In the relationship between PAC and LV diastolic function, PAC was negatively correlated with EIA (r=-0.35, p<0.05) only in the subgroup with normal relative wall thickness (i.e., without the concentric change in LV geometry). A multiple linear regression analysis showed that PAC was one of the independent determinants of E/A in the overall subject group. These observations indicate that PAC is associated with the eccentric change in LV geometry in patients with treated essential hypertension and also suggest that the increase in PAC participates in the impairment of LV diastolic function apart from the concentric change in LV geometry, although concentric hypertrophy clearly impairs LV diastolic function.