Assessment of diastolic reserve in hypertensive patients by dobutamine stress Doppler tissue imaging

Abstract

Background: Many hypertensive patients are symptomatic mainly with exercise, because of the rise in filling pressures. Therefore, it is useful to evaluate left ventricular filling pressure with exercise. The study aims to determine the role of dobutamine stress echocardiography in assessment of diastolic reserve in hypertensive patients with normal ejection fraction. Methods and results: 30 Hypertensive patients (53.8 ± 4.1 years) and 20 sex and age-matched healthy controls (51.9 ± 9.7 years) were recruited. Patients with coronary artery disease, significant valvular disease, hypertrophic cardiomyopathy, left ventricular systolic dysfunction (EF <50%), atrial fibrillation and bad echogenic view were excluded. All groups underwent complete conventional echo and dobutamine stress echocardiography using pulsed wave Doppler tissue imaging at rest and during peak stress to measure early mitral inflow diastolic wave velocity (E), late mitral inflow diastolic wave velocity (A), E/A ratio, early diastolic myocardial wave velocity (E′) and late diastolic myocardial wave velocity (A′). At rest; E′ was significantly lower in patients than controls (9.3 ± 1.8 vs 14.9 ± 2.4 P value <0.001) and E/E′ (early mitral inflow diastolic wave velocity/early myocardial diastolic wave velocity) was significantly higher in patients (7.7 ± 1.3 vs 5.1 ± 1.0 P value <0.001). At peak stress; E/A ratio was significantly lower in patients (P < 0.001) while E/E′ was significantly higher in patients than controls (8.4 ± 2.2 vs 4.8 ± 0.8 P value <0.001). Conclusions: Dobutamine stress echocardiography using Doppler tissue imaging is useful in hypertensive patients with exertional dyspnea with normal resting filling pressure.

Keywords

• Hypertension
• Diastolic function
• Dobutamine stress
• Doppler tissue echocardiography