Right ventricle diastolic function in hypertensive patients

AJH–May 2003–VOL. 16, NO. 5, PART 2

P-373 RIGHT VENTRICLE DIASTOLIC FUNCTION IN HYPERTENSIVE PATIENTS Anis Lutfullaevich Alyavi, Dina Iosifovna Arnopolskaya, Valentina Yurievna Goloskokova. Functional Department, Scientific Research Institute of Medical Rehabilitation, Tashkent, Uzbekistan. Aim of this study were determination of correlation of changes of diastolic function of right (RV) and left ventricle (LV) in patients with essential arterial hypertension. 98 new founded hypertensives and 18 healthy volunteers were examined with pulse-wave Doppler echocardiography for determination of parameters of RV diastolic filling and connection between ones and diastolic function and remodeling of LV. We determined that positive correlation between isovolumic relaxation time in both ventricles increase with growth of LV myocardial mass: in patients with LV hypertrophy (n⫽36) r⫽0.67 (p⬍0.01) and in patients without one (n⫽62) r⫽0.48 (p⬍0.05). Correlation between early diastolic fraction of LV and RV was middle in patients with normal type and eccentric hypertrophy of LV (r⫽0.34, p⬍0.05) and strong in patients with concentric remodeling and concentric hypertrophy of LV (r⫽0.62, p⬍0.01). In control group we did not observe any connection between above mention parameters. Diastolic function of RV in hypertensives is impaired according to changes of LV’s one. Correlation between filling of both ventricles is increased with growth of LV myocardial mass and concentric transformation. It can be explained with ones mechanisms of neuro-humoral regulation of myocardial remodeling (renin-angiotensin system etc.) and one middle and external layers of myocardium for both ventricles. Key Words: Right ventrial function

P-374 INFLUENCE OF VALSARTAN ON MORPHOFUNCTIONAL STATE OF LEFT VENTRICLE IN HYPERTENSIVE PATIENTS Dina Iosef Arnopolskaya, Anishon Lutfulla Alyavi, Valentina Yuriy Goloskokova. Functional Diagnostic, Scientific Research Institute of Medical Rehabilitation, Tashkent, Uzbekistan. Aim of this study were determination of morphofunctional state of left ventricle (LV) in hypertensives with different type of LV remodeling and changes of ones under valsartan treatment. 39 new founded hypertensives before and after 6-mounthly therapy of valsartan and 18 healthy volunteers were examined for determination type of LV remodeling and parameters of LV’s morpho-functional state. Thickness of interventricular septum and LV’s posterior wall, relative wall thickness by ASE, LV myocardial mass by Penn convention, indexed by body surface, endsystolic and enddiastolic myocardial tension and LV myocardial rigidity by Flashskampf F.A. et al were estimate with echocardiography and pulse-wave Doppler. Distribution of LV remodeling types was: normal geometry of LV (NG) – 36%, concentric transformation of LV (CT) – 49% and eccentric hypertrophy of LV (EH) – 15%. In the time of treatment we observed decrease of absolutely and relative LV wall thickness result in LV myocardial mass index decrease on 12.6⫾4.8% (p⬍0.01) in CT (vs. 11.2⫾5,7% (p⬍0.05) in NG and 9.3⫾6.8% (p⬍0.05) in EG (pANOVA⬍0.05)). Index of LV hypertrophy compensation (EDV/ MMLV) increased to (NG/CT/EH) 68.5⫾4.8/57.8⫾5.3/59.4⫾7.2 vs. 74.0⫾9.6 in control group (on 11.5⫾4.8% (p⬍0.05)/29.6⫾6.3% (p⬍0.01)/13.7⫾7.8% (p⬍0.05), accordingly, pANOVA⬍0.05). Decrease of blood pressure and postload results in decrease of endsystolic myocardial tension on (NG/CT/EH) 12.8⫾5.6% (p⬍0.05)/ 14.8⫾4.7%(p⬍0.01)/10,1⫾5.9% (p⬍0.05), pANOVA⬍0.05. In diastolic function we observed decrease of LV myocardial rigidity on (NG/CT/EH) 12.4⫾3.6% (p⬍0.05)/16.9⫾5.6% (p⬍0.01)/9.7⫾5.3%

POSTERS: Cardiac Structure and Function

173A

(p⬍0.05) (pANOVA⬍0.05) result in decrease of enddiastolic myocardial tension on 15.6⫾5.7% (p⬍0.05)/18.9⫾4.8% (p⬍0.01)/12.7⫾8.4% (p⬍0.05), accordingly, pANOVA⬍0.05. Renin-angiotensin system block with valsartan (block of angiotensin-1 receptors and activation of angiotensin-2 receptors) in 6-month therapy results in improvement of morpho-functional state of myocardium of LV and promotes to reverse of LV remodeling. Key Words: Valsartan, Angiotensin recehtor blocker, Myocardial rigidity

P-375 THE LEFT VENTRICULAR HYPERTROPHY INFLUENCE UPON HEMODYNAMIC CHANGES IN HYPERTENSIVE PATIENTS Elena G. Kupchinskaya, Elena V. Bobrova, Viktor G. Lizogub, Larissa V. Bezrodna. Dept. of Hypertension, Institute of Cardiology, Kiev, Ukraine. The purpose of the study was to estimate the left ventricular hypertrophy (LVH) influence on LV systolic function (LVSF) during physical exercise (PE) in essential hypertension (EH) patients (pts) with equal initial blood pressure (BP) level. The EH pts with initial systolic accordingly and diastolic BP 160-180 and 100-110 mm Hg accordingly were divided into three groups in dependence on LVH grade:1 gr. – without LVH (n⫽18 pts); 2-nd – with mild (n⫽29 pts); 3-d – with significant LVH (n⫽12 pts). The LVSF indexes were studied by echocar-diography during rest and PE at standart level (50 W). The systolic and diastolic BP and heart rate did not differ ( p⬎0,05). during rest in all groups. In group pts stroke volume (SV) increased on 25% ejection fraction (FE) increased on 14% (P⬍0,01) at load 50 W. In gr.2 pts SV and EF at PE increased less significant (p⬍0,05) not having changed in gr.3 pts. Thus the increasing of LVH grade made for the deteriora-tion of LVSF during PE not depending on initial BP level. Key Words: Left ventricular hypertrophy, hemodynamic changes, essential hypertension

P-376 IN LONG-STANDING HYPERTENSIVE PEOPLE THE MAXIMAL EXERCISE CAPACITY IS RELATED TO CARDIOVASCULAR STRUCTURE Maria Leonarda De Rosa, Antonio Baiano, Carlo Duilio, Massimo Chiariello. Cardiology Unit,Faculty of Medicine, University of Naples, “Federico II”, Naples, Naples, Italy; Geriatric unit, University of Naples “federico II”, Naples, Naples, Italy. Cardiovascular hypertrophy in patients with never-treated hypertension has been associated with impaired exercise capacity,but we assessed the hypothesis that this relationship remains in long standing hypertensive people and target organ damage is less elucidated.Overall there are no data on the prognostic value of cardiopulmonary exercise testing in this population. In 62 unmedicated 35 to 58 aged patients with essential hypertension I-II WHOstage and electrocardiographic left ventricular hypertrophy, we measured maximal workload and oxygen reserve by cardiopulmonary exercise test,left ventricular mass index by echocardiography according to AHA reccommendations. People did not achieve the maximal workload as predicted by age, gender and body composition [118(102-136) vs138( 118-150) Watts, p⫽.01].This impaired exercise capacity,calculated as the ratio between achieved and predicted maximal workload,was in multiple regression analyses related to lower oxygen reserve (r⫽0.47, p⬍.001), and the lower oxygen reserve to higher Left Ventricular Mass Index, by echo,(␤⫽ -0.36),respectively. In conclusion,people with long standing hypertension and target organ damage cannot achieve the predicted maximal workload.This impaired exercise capacity was associated with lower oxygen reserve but, other-