Patterns of diastolic dysfunction in left ventricular hypertrophy.

Abstract

SUMMARY The relative sensitivities of and interrelations between different measurements of diastolic function were studied in 50 patients with left ventricular hypertrophy diagnosed on anatomical grounds. Isovolumic relaxation time, the interval from minimum cavity dimension to mitral valve opening and relative dimension increase during this period, and the peak rate of dimension increase and wall thinning during rapid ventricular filling were measured by digitised M mode echocardiography. The relative heights of peak early diastolic and atrial velocities (a/E) and the time for decline of early diastolic velocity to half its peak value (velocity half time) were measured on continuous wave and pulsed Doppler and the relative height of the "a" wave was measured by apexcardiogram. All sets of values except those of the interval from minimum dimension to mitral opening were unimodally distributed, and all differed significantly from those in 20 age matched controls. The relative height ofthe "a" wave on the apexcardiogram (90% values were abnormal) was the most sensitive method of studying left ventricular diastolic function and peak rate of dimension increase was the least sensitive. Though none of the correlations was high, there were individual associations between peak rate ofdimension increase, a/E, peak wall thinning rate, and velocity half time, and independently between delay in mitral valve opening and dimension change during this period. Other values seemed to be independent of one another, suggesting a different physiological basis.It is concluded that these various abnormal values do not reflect a single underlying disturbance of diastolic function. There are at least four possible discrete abnormalities: prolongation of isovolumic relaxation; incoordination during isovolumic relaxation; reduced rate of rapid filling; and an increase in the relative amplitude of the "a" wave probably caused by increased passive stiffness. These may be present singly or in combination in any patient.Left ventricular diastolic function may be abnormal in various cardiac conditions including coronary artery disease and hypertrophy.'-' These diastolic abnormalities may be associated with limitation of exercise tolerance, added heart sounds, and evidence of increased atrial contraction. They have been detected by an increasing number of invasive and non-invasive methods during isovolumic relaxation, rapid ventricular filling, diastasis, and left atrial systole.' It is still not clear whether these all reflect, to a different extent, a single disturbance of diastole or whether there is more than one independent abnormality. We examined correlations between the Requests for reprints to Dr Leonard M Shapiro, National Heart Hospital, Westroreland Street, London WIM 8BA.

The onset of left ventricular diastolic dysfunction in SHR rats is not related to hypertrophy or hypertension

“…LV diastolic dysfunction, particularly relaxation abnormalities, is usually recognized to be closely associated with the development of left ventricular hypertrophy (LVH) in hypertensive humans and spontaneously hypertensive rats (SHR), a model of human genetic hypertension (35). Nevertheless, in a previous study, we demonstrated LV relaxation impairment in young SHR without LVH (37), subsequently confirmed by Aeschbacher et al (1).…”

Effects of Resistance Training on Ventricular Function and Hypertrophy in a Rat Model

“…However, this kind of hypertrophy is followed by diastolic or systolic dysfunction and a disproportionate increase in the thickness of the LV posterior wall and interventricular septum. 6,7 Moreover, similar adaptations are usually found in athletes who use anabolic steroids associated with resistance training. 7,8 Although several authors [3][4][5] have studied the impact of different sports on cardiac structure, a follow-up study using an animal model has not been used yet to study adaptive changes in resistance training.…”

Doppler-Echo Evaluation of Left Ventricular Diastolic Filling in Patients with Mixed Connective Tissue Disease

“…The following variables were measured and averaged in 5 cardiac cycles in the M-mode echocardiographic ex amination: (1) left ventricular end-diastolic (LVEDD) and end-systolic (LVESD) dimensions [from which fractional shortening (FS) was derived]; (2) interven tricular septal (IVST) and left ventricular posterior wall (LVPWT) thickness at end-diastole; (3) isovolumic relaxation time (IVRT) -taken as the time interval from the onset of the first high frequency vibration of the aortic second heart sound (the timing of aortic valve closure) to the initial separation of the mitral valve leaflets ( fig. 1) [13].…”