[The use of echocardiography left ventricular filling pressures in hypertensive patients with heart failure and preserved systolic function in a North Africa unit day]

N Ali-Tatar Chentir, Y Tir, L Ouabdesselam, M-T Chentir
Annales de Cardiologie et D'angéiologie 2016, 65 (3): 197-202

OBJECTIVE: To assess the left ventricular (LV) filling pressures by Doppler Tissulaire Imaging (DTI) in the management of hypertensive patients with heart failure and preserved systolic function (HF-PEF) in our outpatient clinic. To involve the patient on the basis of their clinical, biological and echocardiography data, in identifying the risk factors that need change.

PATIENTS AND METHODS: From 2004 to 2014, heart failure with preserved systolic function (HF-PEF) has been diagnosed in 200 consecutive hypertensive patients (pts) at our Algerian outpatient unit. Data were collected on blood pressure at the time of the examination, body mass index (BMI), waist, comorbid conditions including dyslipidemia, diabetes and atrial fibrillation (AF). LV ejection fraction>50 % is taken as the including criteria with acquisition as described in the Chamber Quantification update. Left ventricular global systolic function by biplane disk summation Simpson method and diastolic function is assessed by the mitral inflow measurements regarding recommendations for the evaluation of left ventricular diastolic function by echocardiography from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE).

RESULTS: Mean age was 65±11 yrs; 66 % were female; waist circumference in men>102cm and in women>88cm was found in 82 % of the pts and 50 % were diabetics. Body weight (BMI)>30kg/m(2) is depicted in 88 (44 %). Dyslipidemia is depicted in 78 pts (39 %). Ischemic heart disease was diagnosed in 64 pts (32 %); history of thromboembolic event in 78 pts (39 %); valvular disease in 40 pts (20 %). ECG showed AF in 60 pts (30 %), complete left bundle branch block (LBBB) in 20 pts (10 %). The echographic findings were as follow: left ventricular hypertrophy (LVH) in 126 pts (63 %) and left atrial (LA) enlargement in 111 pts (55 %). Mean left ventricular ejection fraction (LVEF) is about 55±10 %. Delayed relaxation (Em/Am<1) and deceleration time>150ms (DT) in 80 pts (40 %), of them, 56 had increased filling pressures (Em/Ea>8 and Ap>Am); pseudo-normal patterns (1<Em/Am<2 and DT<150ms) in 80 pts (40 %); restrictive filling pattern (Em/Am≥2) and short DT<100ms in 40 pts (20 %).

CONCLUSIONS: The hypertensive pts referred for an echo examination are often diabetics and frequently demonstrate preserved left ventricular function with increased filling pressures. This is useful for managing their treatments in the context of a cardiac rehabilitation programme.

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