Diastolic Dysfunction in Persons with Hypertensive Heart Failure: Patients and Methods
After approval by the Medical Ethical Committee of Ahmadu Bello University Zaria, 95 consecutive patients with hypertensive heart failure and 92 age-/sex-matched normotensive apparently healthy controls were recruited into the study. The demographic and clinical characteristics of these subjects were taken from history, physical examination, and routine laboratory investigations. Also included were patients who at the time of examination were in heart failure and had normal blood pressure but had a clear-cut history of hypertension. The WHO/ISH criteria for defining hypertension and Framingham clinical definition of cardiac failure were used to select patients. A patient with equal or greater than 140/90 mmHg or definitive past history of hypertension and had exertional dyspnea, paroxysmal nocturnal dyspnea, raised jugular venous pressure, and S3 or S4 were included in the study.
Excluded from the study were patients who were anemic (PCV <30%), had significant alcohol consumption (60-80 g/day >5years), smoked >10 cigarettes per day, or who had low serum albumin (<3 g/100ml). Also excluded were patients who were diabetic, in renal failure, had valvular or ischemic heart diseases, and intracardiac shunts (VSD and ASD) because of their effect on left ventricular function (LVF). This was just to ensure that patient’s heart failure was most likely due to hypertension alone.
LVF of both the patients and their controls were assessed echocardiographically using ALOKA SSD 1700 two-dimensional echocardiograph/Doppler and Color Flow ultrasound machine. M-Mode measurements were taken in accordance with the Penn Convention. Measurements taken were interventricular septal thickness (IVS), LV posterior wall thickness (LVPW), and LV internal dimension (LVID) in both diastole and systole. canadian pharmacy cialis
The end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and fractional shortening (FS) were calculated automatically by the machine using either the POMBO or the TEICHHOLZ calculation formula.
The E and A wave velocities were measured from pulsed wave Doppler mitral inflow velocity tracing and the E/A ratio, deceleration time (DT), and deceleration rate (DR) calculated. All measurements were taken three times and the average taken.
All values were reported as means ± standard deviation where applicable and percentages to non-quantitative data. Chi-squared and student t tests were used to determine the statistical significance of the difference between the means. A p value of 0.05 or less was considered significant. Linear correlation coefficient between two variables was also used where necessary. kamagra soft tablets