Can abnormal left ventricular function predict diastolic dysfunction?

The authors assessed the prevalence of left ventricular diastolic dysfunction and its relation to function of the longitudinal fibers of the heart in asymptomatic patients with arterial hypertension.

Arterial hypertension (high blood pressure) is the most common risk factor for heart failure in the general population. In particular, left ventricular diastolic function (the function of the chamber that supplies blood to the body during relaxation of the heart) in hypertensive patients is an important component of progression to heart failure. In hypertensive patients, subtle abnormalities of left ventricular systolic function (the function of the chamber that supplies blood to the body during contraction) have been described as often associated with left ventricular diastolic dysfunction.

The present study was designed to investigate determinants of left ventricular diastolic dysfunction with particular focus on longitudinal systolic dysfunction (problems with the contraction of the heart from the base/top to the apex/bottom).

A complete echo-Doppler (echocardiographic information plus Doppler information that creates an image of the heart while allowing for the determination of the speed and direction of blood flow) study was carried out in 1,556 asymptomatic (no symptoms) patients with grade 2 – 3 hypertension. All patients had a left ventricular ejection fraction (fraction of blood that is pumped out of the heart with every heartbeat) of greater than or equal to 50% and no history of heart failure or coronary artery disease. Advanced left ventricular diastolic dysfunction was identified by an average mitral-to-peak early diastolic annular ratio (a method of estimating the pressure in the heart when it is relaxing and filling with blood) of greater than or equal to 13. Less than advanced dysfunction was identified by an average mitral-to-peak early diastolic annular ratio of between 8 and 13.

Overall, left ventricular diastolic dysfunction was present in 18% of patients. Of these, 44.7% had advanced dysfunction while 53.3% had less than advanced dysfunction.

For advanced dysfunction, correct left ventricular long axis function (shortening of the fibers that run from the apex to the base of the heart) was associated with a 46% reduced risk of left ventricular diastolic dysfunction. Wall thickness and age were associated with a 5% increase in the risk of dysfunction, while body mass index was associated with a 6% increase in risk. An abnormal E/A ratio (a marker of function of the left ventricle whereby E is early filling of the relaxed heart and A is the contraction of the atrium, the entry chamber to the heart) was associated with 3 times the risk of left ventricular diastolic dysfunction.

For less than advanced dysfunction, correct left ventricular long axis function was associated with a 32% reduced risk of left ventricular dysfunction. Abnormal left ventricle end-diastolic index (the amount of blood in the ventricle at the end of filling/just before contraction) was associated with a 4% increased risk of left ventricular diastolic dysfunction. E/A ratio was associated with 2.35 times the risk of dysfunction while age was associated with a 3% increase in risk of dysfunction.

The authors stated that an abnormal left ventricle long-axis function was a powerful determinant of any left ventricular diastolic dysfunction in asymptomatic patients with arterial hypertension.