• 31
    Dec
  • Diastolic Dysfunction in Persons with Hypertensive Heart Failure: RESULTS

Ninety-five patients studied were made up of 60 males and 35 females. Ninety-two controls, made up of 54 males and 38 females, were also studied. The majority of the patients were in the fifth decade, followed by the fourth and sixth decades (Table 1). Fourteen patients, made up of four with peripartum cardiac failure, three with moderate anemia in association to cardiac failure, and four with severe renal failure in association to the cardiac failure and three with rheumatic valvular heart disease, were excluded because of its effect on LVF measurement.

Table 1 shows the demographic and clinical characteristics of the study group. There was no statistically significant difference between the controls and the patients with regards to the mean age and the body mass index (BMI). Compared to the controls the patients had increased cardiothoracic ratio (CTR), electrocardiographic LV hypertrophy (ECG-LVH), and elevated systolic, diastolic, and mean arterial blood pressures. The differences were all statistically significant.

Table 1. Study Group Demographic and Clinical Characteristics According to Status

Demographic/Clinical Parameters StatusControl Group Patients Group P Value
Age (years, mean ± SD) SexBody mass index (BMI) (Mean ± SD) Kg/m2 51.4 ± 11.15 54 (M) 38 (F)23.85 ±4.91

52.6 ± 12.01 60 (M) 35 (F)

23.24± 5.3

0. 2517 0.1085
Roentgen Graphic Cardiothoracic ratio (CTR) (Mean ± SD)

0.49 ± 0.05

0.64± 0.07 0.0001*
Electrocardiography ECG-LVH (mm, Mean ± SD)

27.3 ± 7.46

34.5 ±6.16 0.0001*
(mmHg) SBP (Mean ± SD) DBP (Mean ± SD) MAP (Mean ± SD) 125.0 ±9.94 79.7 ± 6.23 94.7 ± 6.54 163.0   ±25.86110.7 ± 16.48

128.1   ± 18.16

0.00001*0.0001*

0.0001*

* P value O.05 (statistically significant); SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure

Echocardiographic findings in the study group include E/A ratio of <1.0 seen in 34 subjects (36.9%) in the control group and 35 subjects (36.8%) in the patients group. Eighty-three patients (87.4%) had EF <50%; none in the controls had EF <50%. The mean of all the echocardiographic parameters of the controls and the patients showed a statistically significant difference (Table 2). This difference is more with the systolic function indices (EF and FS) than with the diastolic function indices (E/A ratio, DT and DR). This is due to the fact that while systolic function was normal in all the control subjects, diastolic dysfunction was found in most of the elderly control subjects who were not in heart failure.

Table 2. Means of Echocardiographic Parameters of Study Group According to Status

Parameter Control Group (n=92) Means ± SDPatients (n=95) P Value
IVSd (cm) 1.04 ±0.21 1.43 ± 0.46 0.0001
LVPWd (cm) 0.88 ± 0.22 1.46 ± 0.26 0.0001
LVIDd (cm) 4.29 ± 0.64 5.48 ± 0.87 0.001
IVSs 1.22 ± 0.25 1.27 ± 0.40 0.005
LVPWs 1.12 ± 0.19 1.36 ± 0.30 0.0001
LVIDs 3.0 ± 0.49 4.57 ± 0.93 0.0001
EDV (ml) 85.42 ± 32.64 154.22 ±55.64 0.00001
ESV (ml) 29.83 ± 15.82 100.64 ±47.44 0.001
EF (%) 66.35 ± 8.37 36.92 ± 15.16 0.0001
FS (%) 30.60 ± 5.87 16.69 ± 7.45 0.0001
LA (cm) 2.97 ± 0.56 3.83 ± 0.74 0.0001
E (m/s) 0.59 ±0.16 0.65 ± 0.23 0.05
A (m/s) 0.53 ±0.11 0.46 ±0.18 0.05
E/A ratio 1.16 ±0.36 1.66 ± 0.90 0.001
DT (msec) 182.86 ±36.40 144.29 ±0.90 0.001
DR (m/sec2) 3.69 ± 1.40 5.38 ± 2.97 0.001
LVM (g) 157.46 ±49.99 336.23 ± 104.60 0.0001
LVMI (g/m2) 86.84 ± 25.2 192.73 ±55.23 0.0001
NB: all showed a significant p value (O.05); IVS: interventricular septal thickness; LVWP: left ventricular posterior wall thickness; LVID: left ventricular internal dimension; d: diastole; s: systole; EF: ejection fraction; FS: fractional shortening; DT: deceleration time; DR: deceleration rate; LVM: left ventricular mass; LVMI: left ventricular mass index

Table 3 shows the relative frequency of diastolic and systolic dysfunction in the patients according to sex. Isolated diastolic dysfunction was seen in 12 patients (12.6%), pseudonormalization in six patients (6.3%), combined diastolic and systolic dysfiinction in 23 patients (24.2%), and restrictive pattern in 25 patients (26.3%). canadian antibiotics

Table 3. Relative Frequency of Diastolic and Systolic Dysfunction in the Patients According to Sex

Type of Dysfunction F Sex (M/F)M Total
Diastolic Dysfunction Isolated diastolic dysfunction (E/A <1.0 and EF >50% or FS >20%) 4 (4.2%) 8 (8.4%) 12 (12.6%)
Pseudonormalization(E/A (1.0-2.0) and DT 150-200 msec) 1 (1.0%) 5 (5.3%) 6 (6.3%)
Restrictive pattern(E/A >2.0 and DT <150 msec) 10 (10.5%) 15 (15.8%) 25 (26.3%)
Combined Diastolic and Systolic Dysfunction (E/A <1.0 and EF <50% or FS <20%) 12 (12.6%) 11 (11.6%) 23 (24.2%)
Systolic DysfunctionIsolated systolic dysfunction (EF <50% or FS <20%) 8 (8.4%) 21 (22.1%) 29 (30.5%)
TOTAL 95 (100%)
Prevalence of diastolic dysfunction = 69.4%

Systolic dysfunction was seen in 83 patients (87.4%) made up of patients from isolated systolic dysfunction group, combined diastolic and systolic dysfunction group, pseudonormalization and restrictive pattern group. The EF and FS showed significant correlation with the systolic blood pressure, means arterial blood pressure, and NYHA functional class (Table 4). While the E/A ratio showed a highly significant correlation with NYHA, it is only weakly so with SBP. Apcalis Oral Jelly

Table 4. Correlation between Echocardiographic Parameters of Left Ventricular Function and Some Demographic and Clinical Parameters of the Patients

Parameters

Age

BMI

SBP

DBP

MAP

NYHA

LVMI

EF

-0.044 +0.082 +0.437** P= 0.0001 +0.187* P=0.032 +0.331** P=0.0001 -0.440** PO.0001 -0.144 P=0.076

FS

-0.011 +0.059 +0.369* P=0.0001 +0.118 0.255** PO.005 -0.456** P=0.0001 -0.102

E/A Ratio

-0.150 +0.048 -0.168* P=0.048 +0.099 -0.024 +0.394** P=0.0001 +0.122

DT

-0.047 +0.082 +0.218* P=0.015 +0.081 +0.160 -0.166 +0.146
* Correlation is significant at the 0.01 levels (one-tailed); ** Correlation is significant at the 0.05 levels (one-tailed)
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