947 Coronary flow reserve and left ventricular function in uncomplicated hypertensive patients: the impact of the concentric geometry
high blood pressure, diabetes, dyslipidemia. According to a I:x)dy mass index (BMI)
< 25, between 25 and 30, or higher than 30, subjects were classified as normals
(NL, 9), overweight (OW, 11) and obese (OB, 23). LV mass index, geometry and
function were assessed by 2-D- guided M-mode echo and Doppler (Aloka SSD
Results: compared to NL and OW, OB showed significantly higher (p < 0.05)
BP (t t 74-12/674-1 t, 1224-10/784-6, 1324-13/854-8 mmHg), waist circumlerence
(79.84-9.3, 92.34-5.5, 108.34-13.1 cm), plasma fasting C-peptide (1.544-0.15,
1.854-0.59, 2.724-1.14 ng/ml), and mildly elevated LV mass index (LVMI: 364-9,
384-5, 434-12 g'm-2.7, p = n.s.). LV relative wall thickness, ejection #action, stress-
adjusted midwall shortening and DopplerKlerived stroke volume were normal, and
comparable between groups.
In the linear regression analysis, LV mass index was directly related (p< 0.01-
0.05) to waist circumlerence (r=0.49), BMI (r=0.50), C-peptide (r=0.46), systolic
BP (r=0.31) and stroke volume (r=0.45), In the multivariate analysis, only waist
circumference resulted independently related to LVMI (adjusted r2=0.27). No sig-
nificant relations with LVMI were lound for age, LV end-systolic stress, and lasting
Conclusions: in our study population including otherwise healthy normotensive
subjects with isolated obesity and preserved LV function, obese patients show
mildly elevated LV mass index with normal LV geometry. In this early stage el
obesity-associated heart involvement, metabolic laclors are better predictors el
LVMI than hemodynamic laclors. In particular visceral adiposity, roughly estimated
by waist circumference, seems to play a major role.
Let atrial remodeling in chronic hypertension during pregnancy
A.V. Matlioli 1, A. Latlanzi 1 , S. Bonalti 1, M. Zennaro 1, I. Paini 1, F. Facchinelli 2 ,
I. Blasi 2 , G. Maltioli 1. r University of Modena & Reggio Emilia, Dept. of Cardiology,
Modena, Italy; 2University of Modena and R.E., Dept of obsthetrics, Modena, Italy
The present study evaluated left atrial (LA) dimension during pregnancy in patients
(pls) with chronic hypertension (CH) compared with pts with gestalional hyperten-
sion (GH). Pts population included 12 with GH (mean age 294- 4 yrs) and 12 pls
with CH (mean age 294- 4 yrs) LA diameters were measured during systole lrom
the paraslernal long axis view lrom M-mede and from the apical lour-chamber view
from 2D. LA volumes were determined at mitral valve opening (max vol) and at mi-
tral valve closure (min vol)and at the R LA volumes were measured Item the apical
4-chamber and 2-chamber views by means el the biplane area-length method,
and corrected for body surlace area.LA conduit vol, passive emptying vol and ac-
tive emptying vol were calculated.Results of serial evaluation of LA size are shown
in table 1.
LA antero poster diam (mm)
La supero-inf diam (mm)
Maximal vol (em "3)
Minimal vol (cm 3)
P atrial vol (cm '3)
Conduit vol (cm 3)
passive emptying vol (cm a)
active emptying vol (em a)
* p<O05 t" p<O.01
Left atrial dimension and volumes increase during pregnancy. Patients with chronic
hypertension have higher volume compared with gestational hypertension. The
increase in LA diameter is more marked for the supero-inferior diameter in ges-
tational hypertension suggesting a hemodynamic elfect due to the increase el
preload during pregnancy. This effect is less evident in chronic hypertension due
to chronic remodelling ,31 atrial shape and to a decrease stiffness el atrial walls.
Coronary flow reserve and let ventricular function in uncomplicated
hypertensive patients: the impact of the concentric geometry
M. Galderisi 1, A. D'Errico 2 , S. Cicala 2 , P. Innelli 2 , C. Romano 2 , M. Pardo 2,
G. de Simone 2 , O. de Divitiis 2 . 1 Naples, Italy; 2Federico II Universi~ Clinical and
Experimental Medicine, Naples, Italy
Purpose: Few information is available about the relation between left venlricular
(LV) lunction and coronary microcirculalion in arterial hypertension. This study in-
vestigates associations among coronary flow reserve (CFR) and both LV systolic
and diastolic function, in relation to patterns el LV geometry.
Methods: Filty-nine newly diagnosed, untreated hypertensive patients (mean age
= 50 years), underwent lransthoracic standard Doppler-echocardiographic exami-
nation and low.lose diwridamole challenge (0.56 mg,,'kg i.v. in 4 minutes) to record
color-guided, pulsed Doppler flow velocities in distal lelt anterior descending artery.
CFR was estimated as the ratio between dipyridamole and resting coronary dias-
tolic peak velocities. According to age-normalized partition value el relative wall
thickness (RWTn), patients were divided into 2 groups: 23 with LV concentric ge-
ometry (RWTn>0.41) and 36 with normal LV geometry (RWTn<O.41).
Results: The 2 groups were comparable for age, body mass index and blood
pressure. Compared to patients with RWTn<O.41, those with RWTn>O.41 exhib-
lied higher LV mass (p<O.05), lower circumlerential end-systolic stress (p<O.O02),
lower midwall lraclional shortening (p<O.O02), no difference in endecardial lrac-
lional shortening, lower lransmilral E peak velocity (p<O.05) and longer isovolumic
relaxation time p<O.02). CFR was lower in patients with RWTn>0.41 (1.84-0.4)
than in those with RWTn<O.41 (2.14-0.4, p<O.O05), due to lower dipyridamole
coronary diastolic peak velocities (p<O.01). Lower CFR was associated with lower
midwall lraclional shortening (r = 0.37, p<O.O05), lower lransmitral E peak veloc-
ity (r = 0.28,p<0.05) and longer isovolumic relaxation lime (r = -0.31, p<O.01).
However, alter controlling lor heart rate, mean blood pressure and RWTn, only
the relation between CFR and isovolumic relaxation time remained significant (r =
Conclusions: In uncomplicated arterial hypertension lower midwall mechanics is
associated with lower CFR, a relation depending on concentric geometry el the
left ventricle. CFR is also negatively related to prolonged diastolic isovolumic re-
laxation, independent el changes of LV geometry. These findings suggest that al-
tered mechanisms el LV active relaxation might contribute to impair diastolic flow
in coronary microcirculalion
Comparision of electrocardiography with M-mode echocardiography in
detection of hypertensive let ventricular hypertrophy in Nepalese
R Acharya, R Karki, O. Prakash, S. Sharma. B PKoirala Institute of Health
Sciences. Internal Medicine, Dharan. Nepal
Objective: To see the correlation between electrocardiography and echocardio-
graphy for the detection of left ventricular hypertrophy in hypertension in Nepalese
Inclusion Criteria: Patients with blood pressure more than 140/90mmHg or a known
hypertensive on treatment.
Exclusion Criteria: 1. Electrocardiography: Presence el any one or combinations
o! complete bundle branch block or evidence el myocardial infarction or Wolf-
Parkineon-White syndrome or atrial fibrillation.
2. Echocardiography: Presence of any one or combinations el regional wall motion
abnormality or ventricular aneurysm or severe right ventricular volume overload or
hypertrophic cardiomyopathy or aortic stenesis.
Methods: We conducted a cross-sectional observational type el study in 1 O0 con-
seculive patients lulfilling the inclusion and exclusion criteria from 1st June 2003
to 31st May 2004 at BP Koirala Institute el Health Sciences, Dharan, Nepal.
1. Electrocardiography was done and left ventricular hypertrophy was detected
by:(a)Romhilt - Estes Point Score: A score equal or more than 5.(b)Sokolow -
Lyon Voltage Criteria: R wave in V5 or V6 > 26ram and/or sum el S wave in lead
V1 and R wave in V5or V6 >35mm.
2. Echocardiographic measurements were done on standard M-mode as per
American Society of Echocardigraphy recommendations. A lelt ventricular mass
index el more than t t 6.07 gm/m 2 in men and 104.36 gm/m 2 in women were taken
as lelt ventricular hypertrophy. Lelt ventricular mass (LVM) was calculated using
Devereux formula: LVM = 1.04 (LVIDd + IVSTd + LVPWTd) 3 - (LVIDd) 3 _ l&6gm
Left ventricular mass index (gm/m 2) = LVM/Body surface area.
Resells: Echocardiography detected left venlricular hypertrophy in 64% el pa-
tients.We took it as the gold standard and compared electrocardiographic criteria
Electrocardiography using Romhilt - Esles Point Score and Sokolow - Lyon Volt-
age Criteria could detect 13% and 34% el cases with LVH
Romhill - Esles Point Score had sensitivity of 14%o and specificity el 88% with a
positive predictive value el 69% and a negative predictive value el 36°/0.
Sokolow - Lyon Voltage Criteria had sensitivity el 28% and specificity el 55% with
a positive predictive value of 52% and a negative predictive value el 30%
Conclusion: ECG is a good screening tool lor detection of LVH as it is cheap and
easily available in a resource limited country like Nepal. Frequent and judicious use
of it can help reduce mortality and morbidity due to hypertensive heart disease.
Echocardiographic assessment of left ventricular mass increase during
I. Germanakis 1 , F. Parthenakis 2 , M. Kalmanli s, RE. Vardas 2. 1University
Hospital Heraklion, Crete, Dpt of Pediatrics, Pediatric Cardiology Unit, Heraklion,
Greece; 2 University Hospital, Dpt of Cardiology, Heraklion, Crete, Greece;
aUniversity Hospital, Dpt of Pediatrics, Heraklion, Crete, Greece
Lelt ventricular mass (LVM) increases normaly during childhood.
Aim: We evaluated the best body size predictor el LVM in healthy children.
Patients and Methods: LVM was determined using the Devereux lormel by M-
Mode echocardiography, in a group el 295 healthy children(average age 7.34-4.3
yrs, range 1 month-16 yrs). LVM was indexed on age, weight(W), height(H)and on
the 2nd,2.Tth,third power of height(H2, H2.7, H3).
Eur J Echocardiography Abstracts Supplement, December 2005
by guest on January 2, 2012