Doppler Assessment of the Effects of Isometric Stress on Left Ventricular Filling in Hypertensive Young Adults

Doppler interrogation at the inflow of the left ventricle was used to test the effects of isometric stress on ventricular filling in 7 hypertensive subjects with mild to moderate left ventricular hypertrophy, aged forty-two ± seven years, compared with 9 matched healthy control males. In the hypertensive patients at rest, peak early diastolic (E) velocity was lower, and atrial (A) velocity higher, with lower E/A peak velocity ratios than in normals (p @#x3C; 0.05). These differences were more accentuated during isometric stress. Atrial filling fractions were higher in hypertensives (37±6%) than in normals (24±7%) at rest, p @#x3C; 0.05, and this difference increased during isometric stress (44±9% versus 30±11%). Thus, isometric stress accentuated the reliance of left ventricular filling on atrial contribution and may be applied for the detection of early ventricular filling abnormalities in patients with mild hypertension. The systolic blood pressure and the hypertrophic process were both important determinants of left ventricular diastolic filling.

Fouad FM , Tarazi RC , Gallagher JH , et al: Abnormal left ventricular relaxation in hypertensive patients . Clin Sci 59:411S-414S, 1980.

Smith VE , Schulman P. , Karimeddini MK , et al: Rapid ventricular filling in left ventricular hypertrophy. II. Pathologic hypertrophy. J Am Coll Cardiol 5:869-874, 1985.

Papademetriou V. , Gottdiener JS , Fletcher RD , et al: Echocardiographic assessment by computer-assisted analysis of diastolic left ventricular function and hypertrophy in borderline or mild systemic hypertension. Am J Cardiol 56:546-550, 1985.

Hanarad P. , Mathey DG , Siegert R. , et al: Left ventricular relaxation and filling pattern in different forms of left ventricular hypertrophy: An echocardiographic study. Am J Cardiol 45:15-23, 1980.

Dunn FG , Chandraratna P. , de Carvalho JGR , et al: Pathophysiologic assessment of hypertensive heart disease with echocardiography. Am J Cardiol 39:789-795, 1977.

Snider AR , Gidding SS , Rocchini AP , et al: Doppler evaluation of left ventricular diastolic filling in children with systemic hypertension. Am J Cardiol 56:921-926, 1985.

Caruana M. , Al-Khawaja I. , Lahiri A. , et al: Radionuclide measurement of diastolic function for assessing early left ventricular abnormalities in the hypertensive patient. Br Heart J 59:218-226, 1988.

Rokey R. , Kuo LC , Zoghbi WA , et al: Determination of parameters of left ventricular diastolic filing with pulsed Doppler echocardiography: Comparison with cineangiography. Circulation 71:543-550, 1985.

Sahn DJ , DeMaria A. , Kisslo J. , et al: Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 58:1072-1083, 1978.

Teicholz LE , Kreulen T. , Herman WV , et al: Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 37:7-11, 1976.

Shaikh AM , Lavine SJ : Effect of mitral regurgitation on diastolic filling with left ventricular hypertrophy. Am J Cardiol 62:590-594, 1988.

Grossman W. , McLaurin LP : Diastolic properties of the left ventricle . Ann Intern Med 84:316-326, 1976.

Weisfeldt ML , Schully HE , Fredricksen J. : Hemodynamic determinants of maximum negative dp/dt and periods of diastole. Am J Physiol 227:613-621, 1974.

Inouye IK , Massde BM , Loge D. , et al: Failure of antihypertensive therapy with diuretic, beta-blocking and calcium channel blocking drugs to consistently reverse left ventricular and diastolic filling abnormalities. Am J Cardiol 53:1583-1587, 1984.

Galdangelo F. , Gioradano A. , Tavazzi L. : Hemodynamic assessment by handgrip exercise of patients with recent myocardial infarction: Comparison with cycle ergometry . J Cardiopulmon Rehabil 6:519-526, 1986.