Premium
Assessment of the left ventricular diastolic reserve in essential hypertension: the acute saline load test
Author(s) -
Triposkiadis F.,
Moyssakis I.,
Makris T.,
Hatzizaharias A.,
Hadjinikolaou L.,
Kyriakidis M.
Publication year - 2001
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1046/j.1365-2362.2001.00873.x
Subject(s) - medicine , supine position , cardiology , saline , diastole , doppler echocardiography , blood pressure , essential hypertension
Objectives The aim of this study was to evaluate the significance of the development of a restrictive response to an acute saline load, defined as an increase in the ratio of peak early to peak late diastolic transmitral flow velocity (E/A ratio) associated with a decrease in the deceleration time, in patients with mild to moderate untreated hypertension. Background Recognised abnormal patterns of transmitral diastolic flow include, from ‘best’ to ‘worst’: prolonged relaxation, pseudonormalisation, and restrictive physiology. The common denominator of these transitions is the constellation of an increase in the E/A ratio associated with a decrease in deceleration time. Patients and Methods Sixteen normal control subjects (6 males, 10 females, age 51·6 ± 6·9 years) and 24 patients with mild to moderate untreated hypertension (12 males, 12 females, age 46·8 ± 7·5 years) underwent supine blood pressure measurement with sphygmomanometry, biochemical studies, and transthoracic M‐mode, 2D, and Doppler echocardiography before and after an acute saline load (7 mL kg −1 , maximum 500 mL, NaCl 0·9% within 15 min IV). Results The baseline E/A ratio was lower (0·90 ± 0·14 vs. 1·04 ± 0·18; P < 0·01) and the deceleration time was longer (158·8 ± 19·4 vs. 135 ± 8·9 ms; P < 0·01) in patients with hypertension compared with normotensive controls. However, no patient with hypertension exhibited a transmitral flow velocity pattern compatible with typical prolonged relaxation. A restrictive response to the acute saline load was observed in 12 (50%) of the hypertensive and none of the control subjects. Hypertensive patients with a restrictive response to the acute saline load had a lower baseline E velocity (54·8 ± 8·7 cm s −1 vs. 66 ± 6·4 cm s −1 ; P = 0·003), a lower baseline E/A ratio (0·83 ± 0·13 vs. 0·97 ± 0·12; P = 0·015), and a longer deceleration time (167·5 ± 15·4 ms vs. 150 ± 19·5; P = 0·03) than hypertensive patients without such a response. Conclusion A restrictive response to an acute saline load is indicative of a limited diastolic reserve in patients with mild to moderate untreated hypertension. Further studies are required in order to evaluate the significance of such a response with regards to risk stratification and efficacy of medical treatment in this patient population.