Left ventricular filling: relationship with arterial blood pressure, left ventricular mass, age, heart rate and body build

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The relationships of age, heart rate, body build and, in particular, of arterial blood pressure and left ventricular mass to several Doppler indexes of diastolic function were evaluated in a series of 80 subjects with a wide range of blood pressure levels (106-217/68—144 mmHg). Body build and age results were inversely correlated to the indexes, reflecting the early contribution to left ventricular filling, whereas the increase in heart rate was associated with an increase in late diastolic contribution. Strong correlations (in most instances, P<0.0001) were observed with arterial blood pressure and left ventricular mass: the increase of these parameters was associated with a decrease of early transmitral peak velocity (E peak) and of early filling fraction, with an increase of late diastolic transmitral peak velocity (A peak) and of A: E ratio and, finally, with an increase of both deceleration time of E peak and acceleration time to A peak. Blood pressure or left ventricular mass were also confirmed as strong predictors of nearly all the Doppler-derived diastolic indexes by stepwise multiple regression analysis. When the subjects were subdivided into quintiles according to diastolic blood pressure and the average values of the five subgroups were compared, age, heart rate and body build results were similar in the quintiles while diastolic blood pressure increased stepwise by 10 mmHg. Analysis of variance showed significant differences for ail the indexes of left ventricular filling except deceleration time of and acceleration time to E peak (P<0.05 to P<0.0001) and almost all the echo-Doppler indexes showed a linear trend with diastolic blood pressure and left ventricular mass. These data indicate that with the increase of blood pressure and/or left ventricular mass, a greater proportion of left ventricular filling occurs in late rather than early diastole. This relationship does not seem to be dependent on the confounding effect of age, heart rate and body build, it holds true throughout the whole blood pressure spectrum, from low-normal to severe hypertensive values, and it may reflect an impairment of diastolic relaxation rather than an increased chamber stiffness.

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