Background: Systemic arterial hypertension has clearly been shown to be a major factor in the enhanced incidence of cardiac morbidity and mortality. Relaxation abnormalities are one of the earliest manifestations of cardiac dysfunction and frequently precede systolic dysfunction in hypertension. Severe diastolic dysfunction may cause pulmonary congestion even without any deterioration of systolic function. Thus assessment of left ventricular diastolic filling in individual patients is important from both the diagnostic and therapeutic points of view.
Aim of the work: to evaluate left ventricular diastolic function by pulmonary venous flow with pulse tissue Doppler in hypertensive patients.
Patients and methods: Thirty hypertensive patients of both sexes were included in this study, and admitted at cardiology department of Benha University Hospital during the period from September 2010 to March 2011.The study also included ten apparently healthy volunteers as a control group with matched age and sex. All patients were evaluated by history taken, clinical examination. Conventional echocardiography was performed to all patients to assess LV functions, dimensions and hypertrophy.
Pulmonary venous flow was done by Doppler to measure S, D wave and S/D ratio, also Doppler tissue imaging was performed on mitral annulus at apical four chamber view to measure E", A", and E"/A" ratio.
Results: The maximal early diastolic flow velocity of conventional Echo. of the control group ranged from 45-116 cm/sec with a mean value 75.2+18.9 cm/sec, while that of patients group ranged from 48-76 cm/sec with a mean value 62.1+13.9 cm/sec. there was a significant decrease in mitral E wave in patients than that the control group (P<0.01).
The mean of Em/Am Ratio of the patients group was 0.532+0.10 while that of controls groups was 1.426+0.4 There was significant decrease of E/A Ratio of patient group than in control group (P<0.01). The mean systolic forward flow maximal velocity of patients group was 60.1+9.75 while that of controls was 59.73+6.66, with insignificant difference (P>0.05), also the mean diastolic forward flow maximal velocity of pulmonary venous flow in patients group was 64.8+10.98 while that of controls was 39.09+11.55, with significant increase in D wave in cases than that controls (P<0.01).
The S/D ratio show a significant decrease in patients group than the control in cases it was0.93+0.11 while in control it was 1.43+0.05, the difference was significant (P<0.05).
The sensitivity of tissue Doppler for detection of diastolic function was93.3% versus 70% in pulmonary venous flow, specificity was 90% in tissue Doppler while it was 60% in pulmonary venous flow
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