Association between inappropriateness of left ventricular mass and left ventricular diastolic dysfunction: a study using the tissue Doppler parameter, e/e'

Abstract

Background and objectives: The structural significance of the inappropriateness of left ventricular mass (iLVM) is known to be an important prognostic factor for cardiovascular events; however, the functional changes associated with iLVM have not been established. This study was performed to determine if diastolic dysfunction is associated with iLVM using a tissue Doppler technique.

Subjects and methods: Three hundred sixty consecutive subjects, including 221 hypertension patients from the echocardiography database, were analyzed. Regarding the appropriateness of left ventricular (LV) mass, an observed/predicted ratio of LV mass (OPR) >130% was defined as inappropriate. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), isovolumetric relaxation time (IVRT), and E/early mitral annulus velocity (E'), were compared between the appropriate LV mass (aLVM) group and the iLVM group.

Results: Among transmitral flow parameters, only the E velocity was negatively correlated with the OPR when adjusted for age (adjusted r=-0.107, p=0.04). Based on multiple regression analysis, the OPR (beta=0.163, p=0.003), as well as age (beta=0.286, p=0.0001), systolic blood pressure (beta=0.120, p=0.019), fasting blood glucose (beta=0.098, p=0.042), and male gender (beta=0.157, p=0.002) were independent factors determining E/E'. The cholesterol level was not an independent factor (beta=-0.059, p=0.355). In the iLVM group (n=105), the adjusted E/E' was higher than in the aLVM group (n=255; 11.7+/-3.4 vs. 10.8+/-3.1, p=0.02), while the peak E flow velocity was significantly lower than in the aLVM group (70.9+/-15.1 vs. 75.5+/-17.6, p=0.03).

Conclusion: Inappropriateness of LV mass is independently associated with increased E/E'. Thus, E/E' may be a useful parameter for the evaluation of diastolic dysfunction.

Keywords: Echocardiography; Hypertrophy; Left ventricle.

Fig. 1

Adjusted E/E' by age, gender, BMI, systolic blood pressure, cholesterol level, fasting blood glucose level, and types of antihypertensive medication is significantly higher in the inappropriate LV mass group than the appropriate LV mass group. E: early diastolic peak velocity, E': early mitral annulus velocity, BMI: body mass index, LV: left ventricular.