Morphologic and Functional Heart Abnormalities Associated to High Modified Tei Index in Hypertensive Patients
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ORIGINAL ARTICLE
Morphologic and Functional Heart Abnormalities Associated to High Modified Tei Index in Hypertensive Patients G. Tissera1 • Daniel Piskorz2,3 • L. Citta2 • N. Citta2 • P. Citta2 • L. Keller2 L. Bongarzoni2 • L. Mata2 • A. Tommasi3
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Received: 21 June 2016 / Accepted: 5 September 2016 Springer International Publishing Switzerland 2016
Abstract Introduction LV dysfunction develops early in hypertension, even previously to left ventricular remodeling. Aims To determine the frequency of morphologic and functional heart abnormalities associated to abnormal modified Tei Index in untreated hypertensive (HBP) patients (p) with preserved ejection fraction (pEF). Methods Case–control study. Three groups: (1) HBP without left ventricular hypertrophy (LVH); (2) HBP with LVH; (3) non-HBP controls. Ejection fraction [54 % identified pEF. LVH measured by Devereux method. Systolic and diastolic functions assessed by standard echocardiography and tissue Doppler. 2013 ESH/ESC Hypertension Guidelines normal values were considered. Tei index measured at the lateral and septal LV walls in apical 4-chamber view by tissue Doppler, value [0.40 considered abnormal. Statistical analysis: multifactorial ANOVA test adjusted by sex and age, p \ 0.05 statistically significant. Results The study included 14 controls, 88 HBP p without LVH, and 19 HBP p with LVH. The HBP p sample mean age was 58.7 ± 13.5 years and 52 (44.1 %) were males. Mean Tei Index was 0.35 ± 0.03 in controls; 0.42 ± 0.05 in HBP without LVH; and 0.42 ± 0.06 in HBP with LVH (p \ 0.025). Abnormal Tei Index was present in 2p & Daniel Piskorz [email protected] 1
Centenario National Hospital, Urquiza 3000, 2000 Rosario, Argentina
2
Cardiology Institute Sanatorio Brita´nico SA, Paraguay 40, 2000 Rosario, Argentina
3
Cardiovascular Research Center Sanatorio Brita´nico SA, Paraguay 40, 2000 Rosario, Argentina
(14.3 %) controls; 64 p (72.7 %) HBP without LVH; and 15 p (78.9 %) HBP with LVH (p \ 0.0009). Tissue Doppler’s wave was 8.4 ± 0.9 cm/s in controls; 8 ± 1.6 cm/s in HBP without LVH and 7.8 ± 1.1 cm/s in HBP with LVH. Conclusions (1) Left ventricular dysfunction is frequent in HBP p, even without LVH; (2) modified tissue Doppler Tei index is a useful tool for the diagnosis of left ventricular dysfunction. Keywords Hypertension Case control study Left ventricular dysfunction Modified Tei index
1 Introduction The detection of the clinical syndrome of heart failure with preserved ejection fraction (HFpEF) is more common in hypertensive patients. A multivariate analysis had shown for every elevation of 10 mmHg in systolic blood pressure a 13 % increase in the likelihood of developing heart failure with an ejection fraction greater than 45 %. Hypertension, female gender and new atrial fibrillation are the strongest predictors of new HFpEF [1]. Approximately 50 % of hypertensive patients have left ventricular geometry changes, and about one third of them could develope left ventricular hypertrophy, more often of the eccentric type. On the ot
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