Diastolic Function Changes during Stress Echocardiography in Hypertensive Patients

Background: Some hypertensive patients experience dyspnea with exercise due to rise in filling pressures. So, exercise is helpful to determine left ventricular filling tension. Objectives: This study aims to evaluate the effect of dobutamine stress echocardiography on diastolic function in hypertensive patients with normal ejection fraction. Methods: In this study, 30 hypertensive patients (52.7 ± 3.6 years) and 30 sex and age matched healthy controls (50.8 ± 7.6 years) were examined. Exclusion criteria were patients with coronary artery disease, significant valvular heart disease, hypertrophic cardiomyopathy, left ventricular systolic dysfunction (EF (ejection fraction) < 50%), atrial fibrillation and bad echogenic view. We performed complete echocardiography and dobutamine stress echocardiography with pulsed wave Doppler tissue imaging at rest and during peak stress to measure primary mitral inflow diastolic wave rate (E), late mitral inflow diastolic wave rate (A), E/A ratio, primary diastolic myocardial wave rate (E′) and late diastolic myocardial wave velocity (A’). Results: At rest, E’ was significantly lower in patients than controls (8.2± 1.6 vs 14.7± 2.6 P value < 0.001) and E/E (early mitral inflow diastolic wave rate/early myocardial diastolic wave rate) was significantly higher in patients (7.6± 1.2 vs 4.8± 1.0 P value <0.001). At peak stress, E/A ratio was significantly lower in patients (P < 0.001) while E/E′ was significantly higher in patients than controls (8.3 ± 2.1 vs 4.7 ± 0.7 P value < 0.001). Conclusions: Dobutamine stress echocardiography with Doppler tissue study is effective in the evaluation of hypertensive patients with dyspnea on exertion with normal resting echocardiography.