Intraventricular dispersion of E wave velocity: an alternative measure of left ventricular diastolic function in hypertensive patients?

The E/A ratio (of peak mitral blood flow velocity during early diastole to that during atrial contraction) has limitations in the assessment of diasto lic function. Previous studies have suggested that peak blood flow velocity is normally maintained or increased towards the cardiac apex but that it d ecreases in diastolic dysfunction. We evaluated the proposal that intravent ricular dispersion of E wave velocity is an effective means of assessing di astolic function in hypertensives. Fifty-five untreated hypertensive patien ts underwent echocardiographic examination. Pulsed-wave Doppler recordings were made from the apical four-chamber view. Peak flow velocities were meas ured during early diastole at the level of the mitral valve (E-0), and 3 cm distally (E-3), and during atrial contraction at the level of the mitral v alve (A). Mean peak flow velocities were 64.4 +/- 16.1 m/s for E-0, 50.6 +/ - 17.9 m/s for E-3 and 61.1 +/- 12.1 m/s for A. Peak flow velocity during e arly diastole slowed towards the cardiac apex in most patients (E-3/E-0, ra nge: 0.42-1.86, mean 0.81 +/- 0.29). There was no significant difference in E-3/E-0 between those with and without left ventricular hypertrophy (LVH) (0.76 +/- 0.25 vs 0.82 +/- 0.29, P = 0.39). E-3/E-0 did not correlate with age (r = -0.02, P = 0.89), systolic blood pressure (BP) (r = 0.17, P = 0.20 ), diastolic BP (r = 0.21, P = 0.12) or LVMI (r = -0.11, P = 0.40). In cont rast the E/A ratio correlated strongly with age (r = -0.66, P < 0.0001) and negatively, though not significantly, with systolic BP (r = -0.24, P = 0.0 7), diastolic BP (r = -0.23, P = 0.09) and LVMI (r = -0.23, P = 0.08). Alth ough there is some intraventricular dispersion of E wave velocity in this g roup of hypertensive patients, the ratio of E-3/E-0 correlates poorly with parameters which are known to influence diastolic function. In spite of its limitations, the E/A ratio appears to be a more reliable measure of diasto lic function in hypertensive heart disease than intraventricular dispersion of early diastolic filling.