Myocardial diastolic impairment caused by left ventricular hypertrophy involves basal septum more than other walls: analysis by pulsed Doppler tissueimaging

Objective To assess regional diastolic function in patients with hypertensi on with or without left ventricular hypertrophy using Doppler tissue imagin g, a new tool that analyzes myocardial wall motion 'on-line'. Methods Ten normotensive subjects, 20 hypertensive patients without hypertr ophy and 20 with hypertrophy (left ventricular mass index >50 g/m(2.7)), al l men, underwent Doppler echocardiography and Doppler tissue imaging, which was performed in apical view by placing pulsed sample volume at the level of the basal and middle septum, basal and middle lateral wall, and infero-p osterior wall. Peak velocities and time-velocity integrals of myocardial ea rly (E-m) and late (A(m)) waves and their ratios, regional deceleration tim e and regional relaxation time were measured in each segment. Results Transmitral peak E/A ratio was 1.37 in normotensive subjects, 1.01 in hypertensive patients without hypertrophy and 0.77 in those with hypertr ophy (P < 0.00001). The myocardial diastolic indexes derived by Doppler tis sue imaging worsened at all levels in hypertensive patients without hypertr ophy compared with normotensive subjects. In hypertensive patients with hyp ertrophy, the majority of myocardial diastolic indexes were further impaire d at the basal septal level, but only marginal differences were found in ot her regions, compared with indexes in hypertensive patients without hypertr ophy. The main diastolic indexes were found, using separate intra-group ana lyses, to be more compromised at the basal septum than at other levels only in hypertophic hypertensive patients. The prevalence of regions having pea k E-m/A(m) ratios <1 increased significantly from normotensive subjects to hypertensive patients without hypertrophy, but not significantly from these to the hypertrophic group. Among pooled hypertensive patients, after adjus ting for heart rate and diastolic blood pressure using multivariate models, the septal wall thickness was shown to be an independent determinant of th e diastolic indexes of the basal and middle septum. Conclusions In hypertensive patients without hypertrophy, diastolic dysfunc tion is uniform along the ventricular walls, whereas in those with hypertro phy it is more evident at the basal septal level than in other walls, Overa ll among hypertensive patients, the diastolic properties of the interventri cular septum worsen as the thickness of the septal wall increases, in the p resence and in the absence of hypertrophy. J Hypertens 1999, 17:685-693 (C) Lippincott Williams & Wilkins.