EFFECTS OF VENOUS RETURN REDUCTION IN HYPERTENSIVE PATIENTS - IS THERE A DOPPLER DIASTOLIC DYSFUNCTION INDEX INDEPENDENT OF PRELOAD REDUCTION

The aim of this study was to evaluate the effects of preload reduction on the Doppler transmitral flow pattern in the presence of diastolic dysfunction (hypertensive patients) and normal diastolic function (normal subjects) to identify, if present, one or more indexes of abnormal diastolic ventricular filling independent of variations in preload. For this purpose Doppler echocardiography was performed in 17 patients with hypertension and in 18 normal subjects under basal conditions and after 5 minutes of blood pressure cuff inflation at the root of the four limbs. The two groups showed a similar response to preload reduction: a significant reduction in peak velocity and the time-velocity integral of the E wave and in the ratio of peak velocities of E and A waves. Therefore the differences in left ventricular filling patterns between hypertensive and normal subjects observed under basal conditions were still present after preload reduction. The comparison between normal subjects after preload reduction and hypertensive patients in the basal state showed a higher peak velocity and time-velocity integral of the A wave in the latter (61.2 +/- 16.2 vs 46.2 +/- 9 cm/sec [p < 0.002] and 5.4 +/- 1.8 vs 3.7 +/- 1 cm [p < 0.002], respectively) with no differences in the ratios of peak velocities and time-velocity integrals of the E and A waves. It was concluded that the response of the Doppler transmitral flow pattern to preload reduction appears to be similar in normal subjects and patients with hypertension, irrespective of the presence of diastolic dysfunction, and the peak velocity and time-velocity integral of the A wave may be considered indexes of diastolic dysfunction independent of preload reduction.