Early detection of left ventricular diastolic dysfunction in hypertensive heart disease by color Doppler myocardial imaging.

Aim To determine if Color Doppler myocardial imaging could provide evidence of diastolic dysfunction in patients with hypertension whose pulse-wave Doppler parameters were normal. Method The study included 33 patients (mean age 48±7.3 years) and a control group of 13 sexand agematched healthy individuals. Patientswere divided into two groups according tomean blood pressure (BP) values during 24-hour blood pressure monitoring while under antihypertensive therapy: those with uncontrolled hypertension (n=22) and thosewith controlled hypertension (n=11). All study participants underwent complete standard echocardiography (2D, M-mode, pulsed and continuous Doppler) and a Color Doppler myocardial imaging study. Results Conventional Doppler parameters indicated relaxation disturbances in patients with uncontrolled hypertension, butwerewithin anormal range inpatientswith controlledhypertension at baseline and follow-up. Parameters of global diastolic function measured by Color Doppler myocardial imaging revealed that E’/A’, the ratio between E’-wave (early filling phase) andA’-wave (late diastolicwave due to atrial contraction), was<1 in 57%of segments at baseline in patientswith uncontrolled hypertension, and did not significantly change at follow-up. In patients with controlled hypertension, E’/A’<1 was noted in 4.7% of segments at baseline and in 28.6% of segments at follow-up. Conclusion Regional diastolic dysfunctionmeasuredbyColorDopplermyocardial imagingwas the first sign ofmyocardial dysfunction due to arterial hypertension, while the parameters of global diastolic dysfunction measured by conventional Doppler and Color Doppler myocardial imaging were still normal. Furthermore, in patientswith uncontrolled hypertensionwithmanifested global diastolic dysfunction, therewas a change in late diastolic parameters. Our results point to a potentially important role of Color Doppler myocardial imaging in diagnosing hypertensive heart disease as well as in follow-up of treatment.