Author + information
- Received April 30, 1992
- Revision received October 29, 1992
- Accepted February 24, 1993
- Published online September 1, 1993.
- Yoshiyuki Nakashima, MD∗,
- Takanobu Nii, MD,
- Masaharu Ikeda, MD and
- Kikuo Arakawa, MD
- ↵∗Address for correspondence: Yoshiyuki Nakashima, MD, Department of Internal Medicine, Fukuoka Univeresity, School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-01, Japan.
Objectives. This study investigated 1) the role of left ventricular diastolic nonuniformity in hypertensive left ventricular diastolic dysfunction, and 2) the effect of a calcium channel antagonist on diastolic nonuniformity in hypertensive and normotensive subjects.
Background. Augmented left ventricular nonuniformity contributes to diastolic dysfunction in hypertrophic cardiomyopathy, Impaired left ventricular diastolic function with preserved systolic function has been recognized in hypertension. Therefore, abnormal ventricular regional nonuniformity might also be involved in hypertensive diastolic dysfunction in a milder form of hypertrophy.
Methods. Thirteen patients with established hypertension underwent radionuclide ventriculography before and after nifedipine administration. Indexes of left ventricular function were derived by computer analysis of the time-activityy cure. After a compter subdivided the left ventricle into four regions, a timeactivity curve of each region was constructed to determine an index of left ventricular diastolic nonuniformity. This index was calculated as the sum of the absolute values of time difference between global and regional filling in the septal, the apical and the literal region. Tea normotensive subjects were studied for comparison, Echocardiography was performed in both group,
Results. The two group were matched for age, gender, heart rate, echocardiographic dimensions and systolic function. In the hypertensive group, left ventricular diastolic filling index were impaired, with a negative correlation between peak filling rate and the diastolic nonuniformity index. Although the change in ejection fraction after nifedipine administration was similar in the two groups, the increase in filling rate was larger in the hypertensive patients. The diastolic nonuniformity index decreased after nifedipine in the hypertensive but not in the control group. This decrease correlated with improvad peak filling rate in the hypertensive group.
Conclusions. In hypertensive with preserved systolic function, left ventricular diastoiic nonuniformity increases causing early diastolic dysfunction. Decreased diastolic nonuniformity after pharmacologic intervention contributes to lessened ventricular filling dysfunction, regardless of changes in conditions in hypertension. Thus, diastolic nonuniformity is an important determinant of left ventricular abnormality and be a target of pharmacologic intervention in hypertensive patients.
- Received April 30, 1992.
- Revision received October 29, 1992.
- Accepted February 24, 1993.