고혈압환자에서 좌심실 비후의 지형학적 재형성 양상에 따른 좌심실 이완 기능의 평가 : 도플러 심초음파를 이용한 승모판 및 폐정맥 혈류 양상 분석

Abstract

Background : Left ventricular hypertrophy and diastolic dysfunction have been well established in patients with essential hypertension. The left ventricular adaptation to hypertension represents a variety of spectrums with complex changes in topography. Left ventricular topography and diastolic and systolic function were evaluated in 48 patients with essential hypertension(group 1) and 33 age-matched normal controls(group 2) by transmitral inflow and pulmonary venous flow patterns assessed by Doppler echocardiography. The following Doppler parameters were measured : early(E) and late(A) peak velocities and velocity integrals. E/A ratio, deceleration time of E wave ; systolic(S) and diastolic(D) peak velocities and velocity integrals of pulmonary venous flow, S/D ratio, and atrial reversal peak velocity. Results : 1) There were no significant differences of age, sex, heart rate, and body surface area between the two groups. 2) Systolic and diastolic blood pressures and left atrial dimension and left ventricular mass index and relative wall thickness were significantly increased in group 1. Deceleration time and isovolumic relaxation time were significantly increased in group 1(231.9±47.6msecs vs 202.0±40.7msecs, 106.7±21.4msecs vs 83.2±14.3msecs, p<0.05, respectively), whereas E/A ratio was decreased compared with group 2(1.08±0.35 vs 1.43±0.44, p<0.05). Time-velocity integral of atrial reversal pulmonary venous flow was significantly increased in group 1(1.5v0.5 vs1.3±0.4, p<0.05). 3) In group 1, 47.9% had concentric hypertrophy, 41.7% had eccentric hypertrophy and 10.4% had normal left ventricular mass index and left ventricular dimension. 4) In concentric hypertrophy, thickness of ventricular septum and posterior wall were significantly increased, whereas left ventricular end-diastolic dimension was significantly decreased compared with those of patients with eccentric hypertrophy. 5) There were no significant differnces of peak E velocity, deceleration time of E wave, E/A ratio, time-velocity integral of E and A wave, isovolumic relaxation time between patients with concentric hypertrophy and eccentric hypertrophy. 6) There were no significant differences of pulmonary venous flow pattern between concentric hypertrophy and eccentric hypertrophy. 7)Systolic blood pressure was identified as an independent factor which associated with left ventricular mass index. Conclusion : There were no significant differences in diastolic functional indices assessed by Doppler profiles of transmitral inflow and pulmonary venous flow between the patients with concentric hypertrophy and eccentric hypertrophy. The supine systolic blood pressure was identified as an independent factor associated with left ventricular mass index.