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  • Title: [Reduced distensibility of the hypertensive heart under stress as an early sign of diastolic dysfunction].
    Author: Plehn G, Schwartzkopff B.
    Journal: Dtsch Med Wochenschr; 2005 Mar 18; 130(11):568-73. PubMed ID: 15761784.
    Abstract:
    BACKGROUND: Hypertensive patients often present with exertional dyspnoea. However it is questioned whether it results from a systolic, early- or late diastolic impairment of left ventricular function. PATIENTS AND METHODS: Our study included 21 hypertensive patients (7 female; 14 male, median age 56 years) and 12 controls (4 female; 8 male, median age 52 years). All patients had normal epicardial coronary arteries. Parameters of systolic and diastolic heart function at rest and during exercise were analyzed using a combined hemodynamic and radionuclid-angiographic approach. RESULTS: One principal finding was that the investigated hypertensive patients had a normal ejection fraction during exercise (72 % +/- 11 vs 71 % +/- 10 in the control group). However these patients showed an exercise induced increase of pulmonary capillary wedge pressure (17.4 +/- 8 vs 11.5 +/- 5; p = 0.005), a fixed end diastolic volume (82 +/- 21 vs 104 +/- 23 ml/m (2), p = 0.01) and a reduced stroke volume index (58 +/- 1.2 vs 73 +/- 1.4 ml/m (2); p = 0.007). Radionuclid angiography revealed an increased exercise peak filling rate (6.1+/-1.6 vs 4.8+/-1.8 EDV/s; p = 0.04) in hypertensive patients. We assume that exercise capacity (cardiac index = 8.1 +/- 1.8 vs 8.4 +/- 2.2 l/min x m (2); ns) in hypertensive patients without excessive LV hypertrophy is predominantly preserved by an enhanced contractile state and its favorable effects on early diastolic filling. CONCLUSION: An increased left ventricular stiffness during exercise is an early manifestation of hypertensive heart disease.
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