LEFT VENTRICULAR FILLING PATTERN IN RELATION WITH THE TYPE OF CAVITY REMODELLING IN HYPERTENSIVE PATIENTS

Objective: To evaluate the mitral inflow and diastolic left ventricle parameters in hypertensive patients to detect the onset of systolic dysfunction. Design and method: Patients admitted with arterial hypertension and normal ejection fraction EF.Exclusion criteria was:moderate and severe valvulopathies, cardiomyopathies,ischemic heart disease,secondary forms of hypertension, low ejection fraction,pericardial disease, oncologic disease,arterial pulmonary hypertension. Clinical evaluation and laboratory results excluded patients with end stage renal disease and chronic obstructive lung disease. Echocardiographic parameters used was: diastolic spectral and tisular mitral velocities A,E,a’, e’, E wave deceleration time TDE, left ventricle filling pressure ratio E/e’,indexed myocardial mass IMM, left ventricle ejection fraction LVEF,myocardial wall-stress MWS, relative wall thickness index RWTI Myocardial mass was calculated in relation with body surface area and myocardial wall stress use in calculator Laplace formula:systolic arterial pressure,parietal thickness and the radius of left ventricle cavity. Results: 45 patients evaluated: 24 women and 21 men; 58.8+−3.4 years old. LVEF = 56+− 4%.They were isolated in main groups: group I: IMM increased 178.4 +−23.8 g/m2 surface area and RWTI > 0.45 and group II: IMM increased 182.58+−20.3 g/m2 and RWTI < 0.45.A velocity in group I was = 0.78+−0.25 m/sec and in group II was 0.67+−0.4 m/secTisular velocityes e’ was 0.09 = − 0.04 m/sec respectively 0.12 +− 0.03 m/sec.E/e’ ratio was 12+− 3 group I and 8+− 4 for group II. Conclusions: Most frequently form of left ventricle remodelling was concentric hypertrophy 68% followed by excentric hypertrophy 32%. Distribution by gender was same for women and men. Myocardial systolid wall stress was highest in concentric hypertrophy = 2292+− 560.8 dyne/cm2surface square area. Mitral diastolic flow of diastolic dysfunction type I was associate mostly with concentric hypertrophy. Concentric hypertrophy was associate the lowest systolic tisular velocitIes which sugest that it may be the beginning of the systolic left ventricle dysfunction, indetectable by 2D echocardiographic techniques. The highest values of E/e ’ ratio presented in patients with concentric hypertrophy sugest that the left ventricles filling pressure are increased in this group of patients.