The Use of Left Ventricular Myocardial Stiffness Index as a Predictor of Myocardial Performance in Patients with Systemic Hypertension

Muataz F. Hussein, Asia H. Al-Mashhadani, Samar I. Essa

Department of Medicine, College of Medicine, Baghdad University, Baghdad, Iraq.
Department of Physics, College of Science, Baghdad University, Baghdad, Iraq.

DOI: 10.4236/ijmpcero.2014.33022                

Abstract

Our aim was to investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance. We studied 263 hypertensive patients and 166 healthy subjects as a control group. By using conventional Doppler echocardiography, the following parameters were measured—Left ventricular end diastolic diameter, left ventricular end systolic diameter, transmitral early velocity, isovolumic relaxation time, and isovolumic contraction time. Tissue Doppler imaging (TDI) was used in the measurements of the early mitral annular velocity (Ea) and the diastolic stiffness was obtained by calculating the ratio E\Ea\LVIDd. Index myocardial performance (IMP) was calculated according to following equation (IVCT + IVRT)/ET for both the control group and hypertensive group. Results reveal that the differences in the average value of transmitral early filling velocity (E) between patients and control groups for age range (20 - 49) and (50 - 80) were (−1.91%) and (−3.69%) respectively with p value >0.05 for both groups, and the changes in LVIDd between patients and control groups were 0.42% and 1.29% for age ranges (20 - 49) and (50 - 80) respectively with p value >0.05 for both age groups. A significant difference in IMP between patients and controls has also been observed and the changes were 29.54% and 30.43% for age range (20 - 49) and (50 - 80) respectively with p value <0.05 for both groups. The mean values for E/Ea ratio and for the measured LV stiffness index were significantly higher in hypertensive patients compared with control group (p value < 0.05) for both age groups. In conclusion, LV myocardial diastolic stiffness index and IMP are increased in hypertensive patients.

Keywords

Left Ventricular Stiffness, Systemic Hypertension

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Izzo, J.L. and Gradman, A.H. (2004) Mechanisms and Management of Hypertensive Heart Disease: From Left Ventricular Hypertrophy to Heart Failure. Medical Clinics of North America, 88, 1257-1271.
[2]	Guyton, A.C. and Hall, J.E. (2000) Text Book of Medical Physiology. 10th Edition, Philadelphia B-Sounders Company, 96-109, 229-232.
[3]	Devereux, R.B. and Roman, M.J. (1999) Left Ventricular Hypertrophy in Hypertension: Stimuli, Patterns, and Consequences. Hypertension Research, 22, 1-9. http://dx.doi.org/10.1291/hypres.22.1
[4]	Cohen, G.I., Pietrolungo, J.F., Thomas, J.D. and Klein A.L. (1996) A Practical Guide to Assessment of Ventricular Diastolic Function Using Doppler Echocardiography. Journal of the American College of Cardiology, 27, 1753-1760. http://dx.doi.org/10.1016/0735-1097(96)00088-5
[5]	Nishimura, R.A., Abel, M.D., Hatle, L.K. and Tajik, A.J. (1989) Assessment of Diastolic Function of the Heart: Background and Current Applications of Doppler Echocardiography. Part II. Clinical Studies. Mayo Clinic Proceedings, 64, 181-204. http://dx.doi.org/10.1016/S0025-6196(12)65673-0
[6]	Stoddard, M.F., Pearson, A.C., Kern, M.J., Ratcliff, J., Mrosek, G. and Labovitz, A.J. (1989) Influence of Alteration in Preload on the Pattern of Left Ventricular Diastolic Filling Assessed by Doppler Echocardiography in Humans. Circulation, 79, 1226-1236. http://dx.doi.org/10.1161/01.CIR.79.6.1226
[7]	Tei, C. (1995) New Non-Invasive Index for Combined Systolic and Diastolic Ventricular Function. Journal of Cardiology, 26, 135-136.
[8]	Krumholz, H.M., Larson, M. and Levy, D. (1995) Prognosis of Left Ventricular Geometric Patterns in the Framingham Heart Study. Journal of the American College of Cardiology, 25, 879-884. http://dx.doi.org/10.1016/0735-1097(94)00473-4
[9]	Ommen, S.R., Nishimura, R.A. and Appleton, C.P. (2000) Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures: A Comparative Simultaneous Doppler-Catheterization Study. Circulation, 102, 1788-1794. http://dx.doi.org/10.1161/01.CIR.102.15.1788
[10]	Westermann, D., Kasner, M. and Steendijk, P. (2008) Role of Left Ventricular Stiffness in Heart Failure with Normal Ejection Fraction. Circulation, 117, 2051-2060. http://dx.doi.org/10.1161/CIRCULATIONAHA.107.716886
[11]	Maron, B.J., Gottdiener, J.S. and Epstein, S.E. (1981) Patterns and Significance of Distribution of Left Ventricular Hypertrophy in Hypertrophic Cardiomyopathy. A Wide Angle, Two-Dimensional Echocardiographic Study of 125 Patients. American Journal of Cardiology, 48, 418-428. http://dx.doi.org/10.1016/0002-9149(81)90068-0
[12]	Mulvagh, S., Quinones, M.A. and Kleiman, N.S. (1992) Estimation of Left Ventricular End-Diastolic Pressure from Doppler Transmitral Flow Velocity in Cardiac Patients Independent of Systolic Performance. Journal of the American College of Cardiology, 20,112-119. http://dx.doi.org/10.1016/0735-1097(92)90146-E
[13]	Srivastava, P.M., Burrell, L.M. and Calafiore, P. (2005) Lateral vs Medial Mitral Annular Tissue Doppler in the Echocardiographic Assessment of Diastolic Function and Filling Pressures: Which Should We Use? European Journal of Echocardiography, 6, 97-106. http://dx.doi.org/10.1016/j.euje.2004.07.005
[14]	King, G.J., Murphy, R.T. and Almuntaser, I. (2008) Alterations in Myocardial Stiffness in Elite Athletes Assessed by a New Doppler Index. Heart, 94, 1323-1325. http://dx.doi.org/10.1136/hrt.2008.142083
[15]	Yilmaz, R., Seydaliyeva, T., Unlu, D. and Ulucay, A. (2004) The Effect of Left Ventricular Geometry on Myocardial Performance Index in Hypertensive Patients. Anadolu Kardiyoloji Dergisi, 4, 217-227.
[16]	Kannel, W.B., Dawber, T.R., Kogan, A., Revotskie, N. and Stokes, J. (1961) Factors of Risk in the Development of Coronary Heart Disease. Six Years of Follow-Up Experience. Annals of Internal Medicine, 55, 33-50. http://dx.doi.org/10.7326/0003-4819-55-1-33
[17]	Folkow, B. (1978) Cardiovascular Structural Adaptation: Its Role in the Initiation and Maintenance of Primary Hypertension. Clinical Science Molecular Medicine, 55, 3-22.
[18]	Inouye, I., Massie, B. and Loge, D. (1984) Abnormal Left Ventricular Filling: An Early Finding in Mild to Moderate Systemic Hypertension. American Journal of Cardiology, 53, 120-126. http://dx.doi.org/10.1016/0002-9149(84)90695-7
[19]	Nakamura, M., Wada, S. and Yamaguchi, T. (2006) Influence of the Opening Mode of the Mitral Valve Orifice on Intraventricular Hemodynamics. Annals of Biomedical Engineering, 34, 927-935.
[20]	Garcia, M.J., Thomas, J.D. and Klein, A.L. (1998) New Doppler Echocardiographic Applications for the Study of Diastolic Function. Journal of the American College of Cardiology, 32, 865-875. http://dx.doi.org/10.1016/S0735-1097(98)00345-3
[21]	Lips, D.J., de Windt, L.J., van Kraaij, D.J.W. and Doevedans, P.A. (2003) Molecular Determinants of Myocardial Hypertrophy and Failure: Alternative Pathways for Beneficial and Maladaptive Hypertrophy. European Heart Journal, 24, 883-896. http://dx.doi.org/10.1016/S0195-668X(02)00829-1
[22]	Villari, B., Vassalli, G. and Schneider, J. (1997) Age Dependency of Left Ventricular Diastolic Function in Pressure Overload Hypertrophy. Journal of the American College of Cardiology, 29,181-186. http://dx.doi.org/10.1016/S0735-1097(96)00440-8
[23]	Yamazaki, N., Mine, Y. and Sano, A. (1994) Analysis of Ventricular Wall Motion Using Color-Coded Using Tissue Doppler Imaging System. Japanese Journal of Applied Physics, 33, 3141-3146.
[24]	Harada, K., Tamura, M. and Toyono, M. (2002) Comparison of the Right Ventricular Tei Index y Tissue Doppler Imaging to That Obtained by Pulsed Doppler in Children without Heart Disease. American Journal of Cardiology, 90, 566-569. http://dx.doi.org/10.1016/S0002-9149(02)02541-9
[25]	Mario, J.G. (2006) Comprehensive Echocardiographic Assessment of Diastolic Function. Heart Failure Clinics, 2, 163-178. http://dx.doi.org/10.1016/j.hfc.2006.01.005
[26]	Seok, M.K., Jong, W.H., Se-Joong, R. and Namsik, C. (1998) Index of Myocardial Performance Using Doppler-Derived Parameter in the Evaluation of Left Ventricular Function in Patient with Essential Hypertension. Yonsei Medical Journal, 39, 446-452.
[27]	Nixon, J.V. and Burns, C.A. (1994) Cardiac Effects of Aging and Diastolic Dysfunction in the Elderly. In: Gaasch W.H. and Le Winter M., Eds., Heart Failure and Left Ventricular Diastolic Dysfunction, Lea and Febiger, Philadelphia, 427-435.
[28]	Nearchou, N., Tsakiris, A. and Tsitsirikos, M. (2005) Tei Index as a Method of Evaluating Left Ventricular Diastolic Dysfunction in Acute Myocardial Infarction. The Hellenic Journal of Cardiology, 46, 35-42.