Assessment of Mitral Annular Velocity Provided by Doppler-Tissue Imaging Technique in Hypertensive Patients with or Without Hypertrophy

Global diastolic function parameters are much more impaired in the presence of left ventricular hypertrophy. But, effect of left ventricular hypertrophy on regional diastolic function is a subject requiring farther investigation. The change in diastolic mitral annular velocity in the presence of left ventricular hypertrophy was investigated in 50 patients who had mild to moderate degrees of systemic hypertension according to the criteria defined in the JNC-VI report. The presence of left ventricular hypertrophy was determined according to left ventricular mass index. Left ventricular hypertrophy was absent in 27 patients (group I). There was left ventricular hypertrophy accompanying systemic hypertension in the remaining 23 patients (group II). Twenty-four healthy subjects were taken as control group. Peak systolic (Sm), peak early diastolic (Em), peak late diastolic (Am) velocities and deceleration time of early diastolic wave (Emdt) were recorded from the mitral annular segments (basal septum, basal lateral, basal anterior and basal inferior). Additionally, standard M-mode and Doppler parameters were measured. There was no statistical difference among these 3 groups with respect to age, sex and global diastolic function parameters. In spite of the fact that Em, Am velocities and their ratio (Em/Am) were much more impaired in favour of diastolic dysfunction in group II, the different did not reach rignificance from group I. Emdt duration in group II was significantly found from group I only in the basal anterior segment. In group II patients, based on the existence of Em/Am <1, diastolic function was found impaired in the great majority of four segments examined (3.32±1. segments) and was present in more than half of segments in group I (2.15±1.54 segments). By contrast, number of segments with diastolic dysfunction was very few in the control group (0.54±0.82 segments). Furthermore, correlation existed between the number of segments with diastolic dysfunction and age (r=0.66), left ventricular mass index (r=0.35), systolic (r=0.58) and diastolic (r=0.66) blood pressure (p<0.05 in all of them). We conclude that regional diastolic function is impaired in systemic hypertension. If left ventricular hypertrophy accompanied systemic hypertension, impairment in the regional diastolic function is much more prominent.