Impact of left ventricular mass regression on regional myocardial function - assessment by doppler myocardial imaging

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POSTERS: Cardiac Structure and Function

wise, peak VO2 could be(likewise NYHA class) the strongest prognostic factors in this population. The latter was independently related to left ventricular hypertrophy,suggesting that cardiovascular hypertrophy may reduce exercise capacity by itself. Key Words: cardiopulmonary exercise test, oxygen reserve, maximal workload

P-377 IMPACT OF LEFT VENTRICULAR MASS REGRESSION ON REGIONAL MYOCARDIAL FUNCTION - ASSESSMENT BY DOPPLER MYOCARDIAL IMAGING Marina Z. Deljanin Ilic, Stevan N. Ilic, Dragan B. Djordjevic, Branko K. Lovic. ECHO LAB, Institute of cardiology, Niska Banja, University of Nis, Niska Banja, Serbia, Yugoslavia. The aim of the study was to evaluate does pharmacologically induced reduction in left ventricular mass (LVM) have impact on regional systolic and diastolic myocardial function. Fifty-eight hypertensive type 2 diabetic pts (37 male, 21 female; mean age 55.7 ⫾ 8.9 years) with increased LVM index (LVMI ⬎ 110 g/m2 in F, ⬎134 g/m2 in M) free of CAD, were treated with either ACE inhibitor (ACEI group, n⫽32 pts) or calcium antagonist (CA group, n⫽26 pts) for a period of 24 weeks. Age, sex, duration of hypertension and diabetes did not differ among the groups. Before and after 24 weeks treatment period in all pts LVM index (LVMI) was calculated and in order to evaluate regional myocardial function in the pulsed wave Doppler myocardial imaging (PW DMI, Acuson-Sequoia) examination of left ventricular inter-ventricular septum (IVS) and posterior wall (PW) in the short axis view we calculated peak myocardial velocities (m.v.) of systolic (S), early (E) and late (A) diastolic waves and their ratio E/A (index of regional diastolic function). After 24 weeks treatment period in both groups LVMI decreased, but the degree of LVMI regression was higher in ACEI (P⬍0.005) than in CA group (P⬍0.05). In the ACEI group, after 24 weeks, ratio E/A of IVS increased significantly (from 0.71 ⫾ 0.23 to 0.88 ⫾ 0.24; P⬍0.01) as well as of the PW (from 0.82 ⫾ 0.24 to 0.96 ⫾ 0.26; P⬍0.05); value of S m.v. of IVS and PW also increased but not significantly (IVS: from 7.9 ⫾ 1.7 to 8.2 ⫾ 1.8 cm/s, NS; PW: from 8.7 ⫾ 1.8 to 9.0 ⫾ 1.6 cm/s, NS). In the CA group, after 24 weeks, ratio E/A of IVS and PW increased (IVS: from 0.73 ⫾ 0.19 to 0.82 ⫾ 0.20, NS; PW: from 0.81 ⫾ 0.20 to 0.89 ⫾ 0.23, NS) as well as S m.v. (IVS: from 7.7 ⫾ 1.5 to 7.9 ⫾ 1.7 cm/s, NS; PW: from 8.5 ⫾ 1.7 to 8.7 ⫾ 1.6 cm/s, NS). Conclusion: Pharmacologically induced LVM regression in hypertensive diabetic pts improved regional myocardial function, predominantly diastolic, and these favorable modification is more pronounced in pts with greater degree of LVM regression. Key Words: Left ventricular hypertrophy, Regional myocardial function, Doppler myocardial imaging

P-378 ASSESSMENT OF CARDIAC STRUCTURE, BLOOD FLOW VELOCITIES AND FUNCTION BY ECHOCARDIOGRAPHY IN PATIENTS Jing Gao, Qi Hua. Department of Cardiology,Xuan Wu Hospital, Capital University of Medical Sciences, Beijing, China. The aim of this study was to determine the clinical application of echocardiography in assessing the cardiac structure, blood flow velocities and function and in discriminating between normal subjects and patients with various stages of essential hypertension. Cardiac structure, blood flow velocities and function were measured in 357 patients with essential hypertension and 26 normal subjects by echocardiography . The data were determined with the use of analysis of variance F statistics. Peak flow velocity of early diastole(EPFV) in patients with essential hyper-

AJH–May 2003–VOL. 16, NO. 5, PART 2

tension was similar to normal subjects. However, peak flow velocity of atrial contraction (APFV) was higher than that in normal subjects. The thick of interventional septum (IVS) and posterior wall (PW) were more hypertrophy in patients with essential hypertension, and the diameter of left atrium (LA) was increased in sever hypertension. With increasing blood pressure , the thick of PW increased and it was the best index in discriminating the degree of hypertension. APFV was one of index of left ventricular diastolic function in discriminating between normal subjects and patients with essential hypertension. Key Words: Peak flow velocity of early diastole

P-379 GENETIC PREDISPOSITION TO HYPERTENSION INFLUENCES LEFT VENTRICULAR CHANGES DURING ANTIHYPERTENSIVE THERAPY Anna M Grandi, Elena Barlocco, Eliana Piantanida, Paolo Saggiorato, Andrea Bertolini, Luigina Guasti, Achille Venco. Dept. of Clinical and Biological Sciences, University of Insubria, Varese, Italy. Genetic factors play a relevant role in linking insulin resistance and essential hypertension, also influencing insulin sensitivity during antihypertensive therapy.Insulin resistance can affect left ventricular (LV) diastolic function through hyperinsulinemia that stimulates collagen production.Using digitized M-mode echocardiograms, 24 hour blood pressure (BP) monitoring and oral glucose tolerance test, we evaluated the influence of genetic predisposition to hypertension on LV changes during antihypertensive treatment. We enrolled 36 never-treated hypertensives (H) (24h BP ⬎ 135 and/or 85 mmHg)(20 men, 47⫾10 years; BMI 25.3⫾3.4 Kg/m2) with normal glucose tolerance: 18 with both parents hypertensive (F⫹), 18 with normotensive parents (F-). Before and after 18 months of ACE inhibitor treatment we measured: 24h, day,night systolic and diastolic BP, metabolic clearance rate of glucose (MCR), LV mass index , peak shortening and peak lengthening rate (⫹dD/dt) of LV diameter, peak thinning rate of LV posterior wall (dW/dt). Basal evaluation: HF⫹ and HF- differed only in insulin sensitivity (MCR 8.1⫾1.5 vs 9.5⫾1.3 mg 䡠 Kg-1 䡠 min-1, p⫽0.005) and in LV diastolic function (⫹dD/dt 4.1⫾1 vs 5.1⫾1.3 s-1, p⫽0.014; dW/dt 10.5⫾2.8 vs 12.6⫾2.4 cm/s,p⫽0.021), both lower in HF⫹. After treatment: 24h BP and LV mass index decreased (p⬍0.002) to a similar extent in HF⫹ and HF-; insulin sensitivity increased in HF- (MCR 9.5⫾1.3 to 10.2⫾1.3 mg 䡠 Kg-1 䡠 min-1,p⫽0.0002) and did not change in HF⫹ (MCR 8.1⫾1.5 to 8⫾1.6 mg 䡠 Kg-1 䡠 min-1);LV diastolic function improved significantly (p⬍ 0.005) in both groups, but to a greater (p⬍0.003) extent in HF-; genetic predisposition to hypertension exerted a significant (2-factor ANOVA:p⬍0.0001) effect over changes of insulin sensitivity and LV diastolic function. Genetic predisposition to hypertension, besides affecting insulin sensitivity, influences LV changes during therapy : in HF⫹ unchanged insulin sensitivity was associated with a smaller improvement in LV diastolic function, compared to HF-, despite a similar extent of BP and LV mass decrease. Key Words: left ventricular diastolic function, insulin sensitivity, family history of hypertension

P-380 EFFECTS OF VALSARTAN ON LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH Qi Hua, Dongbao Li, Lin Pi. Department of Cardiology of Xuan Wu Hospital, Capital University of Medical Sciences, Beijing, China. To investigate the effects of Valsartan on left ventricular hypertrophy and its antihypertensive efficacy. Echocardiography was performed in 89 patients with essential hypertension treated by Valsartan before and after