Rapid ventricular filling in left ventricular hypertrophy: II. Pathologic hypertrophy

Abstract

To define the extent of left ventricular ejection and filling abnormalities in patients with mild hypertension, a non-imaging nuclear probe was used to generate high resolution time-activity curves in 25 patients with an average systolic blood pressure of 154 ± 20 mm Hg and diastolic pressure of 98 ± 8 mm Hg. The hypertensive patients did not meet electrocardiographic criteria for left ventricular hypertrophy, and none had evidence of ischemic or other cardiac disease. Compared with 25 age-matched normal subjects who had average systolic and diastolic pressures of 123 ± 10 and 79 ± 8 mm Hg, respectively, the hypertensive patients had a significantly lower ejection rate (2.00 ± 0.20 versus 2.34 ± 0.36 end-diastolic counts/s for the control group, p < 0.05) and ejection fraction (58 ± 4.9 versus 62 ± 4.4) (p < 0.05). The hypertensive patients had a markedly lower average rapid left ventricular filling rate (1.87 ± 0.32 versus 2.69 ± 0.41 counts/s for the control group, p < 0.001).

Although there was a modest inverse relation between echocardiographic left ventricular mass index and filling rate in the hypertensive patients (r = −0.59, p < 0.01), 4 of 12 hypertensive patients with normal left ventricular mass index had a depressed filling rate. All of the hypertensive patients with increased left ventricular mass index had an abnormal left ventricular filling rate (< 1.89 end-diastolic counts/s). There was an inverse correlation of filling rate with age in both hypertensive patients and control subjects (r = −0.59, p < 0.01 and r = −0.65, p < 0.001, respectively). These findings suggest that this radionuclide technique can detect very early effects of hypertension on the left ventricle.