A STUDY OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN HYPERTENSION

INTRTODUCTION: Hypertension is one of the major non communicable disease among the adult population. Hypertension is the leading cause of morbidity and mortality in both developed and developing countries. Hypertension is the leading cause of ischemic heart disease, heart failure and stroke.(1) In spite of having target organ damage, hypertension remains asymptomatic in majority of population. Diastolic dysfunction and left ventricular hypertrophy are the early evidence of hypertensive heart disease, both of which may remain silent.(2) Heart failure is a common and often lethal complication of chronic hypertension. Based on extensive research, it has become possible to focus on individual factors that cause or contribute to the syndrome of chronic heart failure. OBJECTIVE: Main objective of the study of to find out the incidence of left ventricular diastolic dysfunction. METERIALS AND METHODS: All hypertensive patient with systolic blood pressure of more than 140 and or diastolic blood pressure of more than 90 are included in the study. Data was collected from history, clinical examination, ECG, Echo. Coronary angiogram was done in few patients to rule out ischemic heart disease. LV dimensions were obtained by M-mode echo from apical and parasternal windows. Diastolic dysfunction was measured by Doppler echo. RESULTS: 85patients were considered for the study. 62 patients had diastolic dysfunction, 40 patients had LVH. Of the 62 patients, 28 had isolated diastolic dysfunction and 34 patients had both systolic and diastolic dysfunction. Ejection fraction was ranging from 50-77%. Early peak velocity ranged from40cms/secto 120cms/sec with a mean of 71. 21+/-16. 81cms/sec in patients with diastolicdys function, late atrial velocity ranged from 50cms/sec to 150cms/sec with a mean of102. 66cmd/sec+/-19. 13cms/sec. E/A ratio ranged from 0. 41 to 1. 8 with a mean of 0. 69+/-0. 14. CONCLUSION: Since in the introduction of non-invasive methods such as radionuclide vetriculogram and doppler echocardiography, these techniques have become the modalities of choice for the assessment of left ventricular diastolic dysfunction. These have advantages of ease of performance repeatability(4,5,6,7,8) It was concluded from the study that incidence of diastolic dysfunction is72%. 32% had isolated Diastolicdys function and the rest had LVH along with diastolic dysfunction. LV diastolic dysfunction can manifest both as backward failure and forward failure. Diastolicdys function correlated well with the severity of diastolic blood pressure as well as with the duration of hypertension. Doppler echocardiography is an easily available non-invasive technique today, can utilized for early detection of LV diastolic dysfunction. Early detection and more aggressive management of hypertension prevents the long term complications.