Role of tissue Doppler imaging in diagnosis of diastolic dysfunction in patients with hypertension in primary care setting

AJH–May 2005–VOL. 18, NO. 5, PART 2

POSTERS: Cardiovascular Imaging and Hypertension Detection

P-420 ROLE OF TISSUE DOPPLER IMAGING IN DIAGNOSIS OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH HYPERTENSION IN PRIMARY CARE SETTING Ann Glasman. Internal Medicine, Truesdale Clinic, Fall River, MA. HTN is shown to be the most common risk factor for development of congestive heart failure (CHF). Almost 40% of patients with CHF have isolated diastolic dysfunction. Purpose of this study is to develop easy and reliable tool for diagnosis of diastolic dysfunction in patients with HTN in primary care setting. All patients with HTN referred for echocardiographic evaluation by primary care physicians underwent a standardized protocol including pulsed wave Doppler velocities of mitral inflow (E, A, E/A ratio), pulmonary vein and hepatic vein flow, mitral valve deceleration time (DT), isovolumic relaxation time (IVRT), tissue Doppler imaging (TDI) of mitral valve annulus in the 4 chamber view from apical window at septal and lateral walls. Left ventricular (LV) stroke volume and cardiac output was determined by modified Simpson rule. LV mass was calculated by Penn convention equation. 39 subsequent hypertensive patients with normal systolic function and absence of valvular abnormalities were selected as a study group. 25 age matched normotensive individuals served as a control group. Analysis of mitral annulus velocities by TDI showed significantly lower early myocardial diastolic velocities measured both at septal (E’s) and lateral walls (E’l) in hypertensive patients compared with normotensive group (E’s was 6.8⫹/-1.3 mm/s for hypertensive patients and 8.6⫹/2.3 in normotensive group, sig. 0.01; E’l was 9.1⫹/-1.8 for hypertensive patients and 11.4⫹/-4.6 in normotensive patients, sig. 0.02). Mean E to E’ ratio in hypertensive group was 12.1 which was previously shown to correlate with left ventricular end-diastolic pressure more then15 mmHg; in normotensive group mean E to E’ ratio was 8.7 which is known to correlate with normal end diastolic pressure. No significant differences were noted between body surface area, LV mass, mitral inflow velocities E, A or E/A ratio, IVRT, DT, TDI systolic velocities, pulmonary and hepatic veins systolic and diastolic velocities and their ratio and stroke volumes and cardiac outputs when hypertensive and normotensive groups were compared. Incorporating of TDI into routine echocardiograpic examination of patients with hypertension provides quantative measurement of diastolic function. Early diagnosis and treatment of diastolic dysfunction at compensatory asymptomatic patient may prevent it progression to symptomatic stage and irreversible damage. Key Words: Diastolic Dysfunction, Hypertension, Tissue Doppler Imaging

P-421 ASSOCIATION OF CAROTID DISEASE WITH VASOACTIVATORS IN HYPERTENSION PATIENTS Chen Qi Ling. Hypertention Department, People’s Hospital of Perking University, Beijing, Beijing, China. Objective: Discuss the influence of the change of vasoactivors such as nitric oxide and endothelin on the carotid disease when the patients got the hypertension therapy. Methods: After the carotid ultrosound examination, we divide the 120 patients into 4 groups according to their carotid disease. Normal group(30 cases), endothelial thickness group(30 cases), hard plaque group(30 cases) and soft plaque group(30 cases). Measure the concentration of nitric oxide and endothelin in serum of hypertension patients before and after therapy. Results: Compared with non-plaque group, soft plaque group had lower levels of nitric oxide. The difference was notability (P⬍0.05). So was the hard plaque group (P⬍0.05). After our therapy, the number of reach aim blood pressure: (1)normal group is 23, (2)endothelia thickness © 2005 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.

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is 25,(3)hard plaque is 28, (4)soft plaque is 21. The number of stroke after 2 years: (1)normal group is 2, (2)endothelia thickness is 3,(3) hard plaque is 2, (4)soft plaque is 7. We use long-time calcium antagonist to treat those patients. But we found no difference on stroke between the team up to scrath and the team no up to scrath. Conclusion: The difference is evidence between the form of carotid plaque and the endodermis trauma of hypertension. So if we want to give the best protest to the vascular, we must therapy his hypertension first. The change of vasoactivators before and after therapy

NO(umol/L) NO(umol/L) ET-1(pg/ml) ET-1(pg/ml)

pretreament post-treament pretreament post-treament

Normal n ⴝ 30

endothelia thickness n ⴝ 30

hard plaque n ⴝ 30

soft plaque n ⴝ 30

51.9 ⫹ 6.42 52.03 ⫹ 5.21 21.1 ⫹ 4.63 19.6 ⫹ 3.2

51.1 ⫹ 7.6 51.2 ⫹ 6.8 30.6 ⫹ 4.9# 25.8 ⫹ 6.1

19.1 ⫹ 2.3* 36.24 ⫹ 1.96 34.9 ⫹ 4.7# 31.5 ⫹ 2.8

29.8 ⫹ 5.4# 35.51 ⫹ 3.8 29.3 ⫹ 6.9# 25.1 ⫹ 5.3

#P ⬍ 0.05:P ⬍ 0.01 compared with post-treament

Key Words: Carotid Disease, Hypertension, Vasoactivator

P-422 ASYMPTOMATIC CAROTID LESIONS AND AGING: ROLE OF HYPERTENSION AND OTHER TRADITIONAL AND EMERGING RISK FACTORS Glauco Milio, Egle Corrado, Giuseppina Novo, Giuseppe Mazzola, Daniela Sorrentino, Ida Muratori, Rosalba Tantillo, Salvatore la Carrubba, Giustina Vitale, Serafino Mansueto, Salvatore Novo. Internal Medicine and Cardiovascular and Neprourological Disease, University of Palermo, Palermo, Italy; Department of Clinical Medicine and Emerging Pathologies, University of Palermo, Palermo, Italy. Objectives: To evaluate the prevalence of intima-media thickening (IMT) and asymptomatic carotid plaque (ACP) in a group of subjects with or without traditional and/or emerging risk factors (RF) and to research a possible correlation with age and blood pressure. Patients: 631 subjects (313 M and 318 F), aged between 19 and 97 years, asymptomatic for cerebro- and cardiovascular diseases. Methods: Each patient underwent carotid arteries ultrasound. The following biochemical variables were also measured: total cholesterol (TC), HDL-C, LDL-C, triglycerides (TG), fibrinogen, high sensitive C reactive protein (hs-CRP), IgG antibodies (ELISA) for Helicobacter pylori (HP), cytotoxic HP (CTX-HP), Cytomegalovirus (CMV) and Chlamydia pneumoniae (CMP). Finally, we divided the studied population in normotensive and hypertensive subjects and evaluated in each group the frequency of carotid lesions in relation with age. Each group was also subdivided into two subgroups according to the results of the ecocolordoppler examination: 1) subjects with normal carotid; 2) with IMT or with ACP. Results: IMT ⫹ ACP was significantly more frequent in patients ⬎ 65 years in comparison with those ⬍ 65 years (80.6% vs 52.1 in the whole sample, n⫽631, P ⬍ .005; 77% vs 14% in normotensive without RF, n⫽31, P ⬍ .005; 43% vs 25% in normotensive with RF, n⫽260, P ⬍ .005; 89% vs 40% in hypertensive without RF, n⫽14, no significant; 85% vs 65% in hypertensive with RF, n⫽326, P ⬍ .005). Conclusions: Carotid arteries IMT and ACP are significantly more frequent in patients older than 65. However, in all the considered subgroups, hypertension, alone or associated with the total burden of previous infections (CMP, CMV, HP and HP cytotoxic stream), was a strong and particularly important risk factor. Optimal blood pressure control may limit the development of atherosclerotic lesions in young people with hypertension but without other RF. The role of previous infections is very appealing even if further investigations are needed. Key Words: Arterial Hypertension, Carotid Lesions, Infections 0895-7061/05/$30.00