Diastolic dysfunction in hypertensive heart disease is associated with altered myocardial metabolism

Background-Hypertension is an important clinical problem and is often accom panied by left ventricular (LV) hypertrophy and dysfunction. Whether the my ocardial high-energy phosphate (HEP) metabolism is altered in human hyperte nsive heart disease and whether this is associated with LV dysfunction is n ot known. Methods and Results-Eleven patients with hypertension and 13 age- matched healthy subjects were studied with magnetic resonance imaging at re st and with phosphorus-31 magnetic resonance spectroscopy at rest and durin g high-dose atropine-dobutamine stress. Hypertensive patients showed higher LV mass (98+/-28 g/m(2)) than healthy control subjects (73+/-13 g/m(2), P< 0.01). LV filling was impaired in patients, reflected by a decreased peak r ate of wall thinning (PRWThn), E/A ratio, early peak filling rate, and earl y deceleration peak (all P<0.05), whereas systolic function was still norma l. The myocardial phosphocreatine (PCr)/ATP ratio determined in patients at rest (1.20+/-0.18) and during stress (0.95+/-0.25) was lower than correspo nding values obtained from healthy control subjects at rest (1.39+/-0.17, P <0.05) and during stress (1.16+/-0.18, P<0.05). The PCr/ATP ratio correlate d significantly with PRWThn (r=-0.55, P<0.01), early deceleration peak (r-= -0.56, P<0.01), and with the rate-pressure product (r=-0.53, P<0.001). Conc lusions-Myocardial HEP metabolism is altered in patients with hypertensive heart disease. In addition, there is an association between impaired LV dia stolic function and altered myocardial HEP metabolism in humans. The level of myocardial PCr/ATP is most likely determined by the level of cardiac wor k load.