Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy
ABSTRACT We sought to determine the prognostic value of left ventricular (LV) mitral annular velocities measured by tissue Doppler imaging (TDI) in hypertensive patients with echocardiographic evidence of LV hypertrophy.
Echo LV hypertrophy and LV geometry provide additional predictive value of all-cause mortality beyond traditional cardiovascular risk factors. Limited data exist regarding the predictive value of TDI velocities for cardiovascular risk stratification in treated hypertensive patients.
Two-dimensional and Doppler echocardiograms were obtained in 252 consecutive subjects, including 174 subjects with systemic hypertension and 78 age-matched normal subjects. The end point was cardiac death in subsequent median follow-up of 19 months.
Nineteen patients (7.54%) died of cardiac causes. The TDI mitral annulus systolic velocity and the early diastolic mitral annular velocity (Em) were significantly lower in the non-survivors (all P < 0.001). The pseudonormal (PN) or restrictive filling pattern (RFP) was associated with cardiac mortality. The other parameters associated with cardiac mortality were LV ejection fraction, LV mass index, inter-ventricular septal wall thickness in diastole and the ratio of early mitral inflow to early myocardial velocity. In multivariate analysis, Em, inter-ventricular septal wall thickness in diastole and either PN or RFP were the strongest predictors. The addition of Em < 3.5 cm/s significantly improved the outcome of a model that contained clinical risk factors, inter-ventricular septal wall thickness in diastole > 1.4 cm and either PN or RFP (P = 0.043).
Early diastolic mitral annulus velocity measured by TDI provides prognostic information, incremental to clinical data and standard echocardiographic variables, for risk stratification of hypertensive patients under treatment.
SourceAvailable from: Edoardo Casiglia[Show abstract] [Hide abstract]
ABSTRACT: Background Left ventricular (LV) function depends on the activity of transmembrane electrolyte transporters. Failing human myocardium has lower Na+/K+ ATPase expression and higher intracellular sodium concentrations. The ATP12A gene encodes a catalytic subunit of an ATPase that can function as a Na+/K+ pump. We, therefore, investigated the association between LV function and common genetic variants in ATP12A.MethodsA random sample of 1166 participants (53.7% women; mean age 49.5 years, 44.8% hypertensive) was recruited in Belgium, Poland, Italy and Russia. We measured transmitral early and late diastolic velocities (E and A) by pulsed wave Doppler, and mitral annular velocities (e¿ and a¿) by tissue Doppler. Using principal component analysis, we summarized 7 Doppler indexes ¿ namely, E, A, e¿ and a¿ velocities, and their ratios (E/A, e¿/a¿, and E/e¿) ¿ into a single diastolic score. We genotyped 5 tag SNPs (rs963984, rs9553395, rs10507337, rs12872010, rs2071490) in ATP12A. In our analysis we focused on rs10507337 because it is located within a transcription factor binding site.ResultsIn the population-based analyses while adjusting for covariables and accounting for family clusters and country, rs10507337 C allele carriers had significantly higher E/A (P¿=¿0.003), e¿ (P¿=¿5.8x10¿5), e¿/a¿ (P¿=¿0.003) and diastolic score (P¿=¿0.0001) compared to TT homozygotes. Our findings were confirmed in the haplotype analysis and in the family-based analyses in 74 informative offspring.ConclusionsLV diastolic function as assessed by conventional and tissue Doppler indexes including a composite diastolic score was associated with genetic variation in ATP12A. Further experimental studies are necessary to clarify the role of ATP12A in myocardial relaxation.BMC Medical Genetics 11/2014; 15(1):121. DOI:10.1186/s12881-014-0121-6 · 2.45 Impact Factor
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ABSTRACT: The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination of hypertensive patient; indeed when LV diastolic function is impaired, it is possible to have heart failure even with preserved LV ejection fraction. Left ventricular diastolic dysfunction (LVDD) occurs frequently and is associated to heart disease. Doppler echocardiography is the best tool for early LVDD diagnosis. Hypertension affects LV relaxation and when left ventricular hypertrophy (LVH) occurs, it decreases compliance too, so it is important to calculate Doppler echocardiography parameters, for diastolic function evaluation, in all hypertensive patients. The purpose of our review was to discuss about the strong relationship between LVDD and hypertension, and their relationship with LV systolic function. Furthermore, we aimed to assess the relationship between the arterial stiffness and LV structure and function in hypertensive patients.Journal of Clinical Medicine Research 03/2015; 7(3):137-44. DOI:10.14740/jocmr2050w
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ABSTRACT: Echocardiographic evaluation of diastolic properties and assessment of hemodynamic status of the right and the left ventricle have been traditionally applied for many years in clinical practice. Establishment of diagnosis of diastolic dysfunction, grading, and estimation of filling pressures noninvasively adds prognostic information to the clinician, which may affect treatment management. Novel methods, including left atrium strain, left ventricular diastolic strain rate, and left ventricular untwisting rate, have been imported in clinical practice attempting to provide a more comprehensive and more accurate understanding of the mechanisms and diagnosis of diastolic dysfunction.Current Cardiology Reports 02/2015; 17(2):561. DOI:10.1007/s11886-014-0561-9