Author + information
- Received January 29, 1990
- Revision received August 1, 1990
- Accepted August 17, 1990
- Published online February 1, 1991.
- Anthony C. Pearson, MD, FACC*,1,
- Chalapathirao Gudipati, MD1,
- David Nagelhout, MD1,
- James Sear, MD1,
- Jerome D. Cohen, MD1 and
- Arthur J. Labovitz, MD, FACC1
- ↵*Current address and address for reprints: Anthony C. Pearson, MD, Ohio State University, Division of Cardiology, 657 Means Hall, 1654 Upham Drive, Columbus, Ohio 43210-1228.
One hundred four participants in the Systolic Hypertension in the Elderly Program (SHEP) trial (mean age 71 ± 6 years) were examined by Doppler echocardiography to gain information on the cardiac structural and functional alterations in isolated systolic hypertension. Participants had a systolic blood pressure >160 mm Hg with diastolic blood pressure <90 mm Hg and were compared with 55 age-matched normotensive control subjects. Left ventricular mass index was significantly higher in the participants than in the normotensive subjects (103 ± 28 versus 87 ± 23 g/m2, p = 0.0014) and 26% of the participants met echocar-diographic criteria for left ventricular hypertrophy compared with 10% of normotensive subjects. Left atrial index was also greater in participants than in normotensive subjects (2.26 ± 0.32 versus 2.11 ± 0.24 cm/m2, p = 0.005) and 51% of participants had left atrial enlargement.
Doppler measures of diastolic filling were significantly different between the two groups, with peak atrial velocity higher (76 ± 17 versus 69 ± 17 cm/s, p = 0.02) and ratio of peak early to atrial velocity lower (0.76 ± 0.23 versus 0.86 ± 0.22, p = 0.0124) in participants. There was no correlation between left ventricular mass index and Doppler measures of diastolic function, but relative wall thickness correlated significantly with peak atrial velocity (r = 0.22, p = 0.016) and peak early to peak atrial velocity ratio (r = 0.24, p = 0.007).
There was no difference in M-mode ejection phase indexes of systolic performance (shortening fraction and peak velocity of circumferential fiber shortening) between the two groups. However, the end-systolic stress/end-systolic diameter index ratio was significantly increased (36 ± 9 versus 32 ± 6, p = 0.0067) and Doppler-derived pre-ejection period/ejection time ratio was significantly reduced in participants (0.218 ± 0.091 versus 0.319 ± 0.117, p = 0.0001).
Thus, elderly patients with isolated systolic hypertension have a high prevalence of left ventricular hypertrophy, well preserved systolic function and abnormal diastolic filling in comparison with age-matched control subjects.
With the technical assistance of Denise Mrosek, Jan St. Vrain
- Received January 29, 1990.
- Revision received August 1, 1990.
- Accepted August 17, 1990.
- American College of Cardiology Foundation