e-Herz: Original article Herz 2014 DOI 10.1007/s00059-014-4098-x Received: 2 January 2014 Revised: 6 March 2014 Accepted: 14 March 2014 © Urban & Vogel 2014
e-Herz
Left ventricular (LV) diastolic dysfunction is usually the early finding in patients with hypertension, which can increase the risk of heart failure and cardiovascular mortality, even if at an asymptomatic or preclinical stage but the exact mechanism remains unknown [1, 2, 3, 4, 5, 6]. However, the elevation of homocysteine (Hcy) levels is now known to be an independent risk factor for vascular diseases and high Hcy (Hhcy) levels are more common in Chinese patients with hypertension due to their special genetic background [7]. It can promote oxidant damage to the vascular endothelium, impair endothelium-dependent vasomotor regulation, and may also alter the coagulant properties of the blood [8, 9]. Whether Hhcy has any effect on LV diastolic dysfunction in patients with hypertension has not been clarified as yet. The aim of this study was to assess the influence of Hcy on LV diastolic function in Chinese hypertension patients with Hhcy.
Patients and methods Participants The present study was cross-sectional and observational, including 74 consecutive patients with hypertension who underwent a complete transthoracic echocardiographic examination as well as measurements of E/e’, e’/a’, and other diastolic parameters. The study participants consisted of 37 hypertensive patients with-
L. Ruhui · J. Jinfa · X. Jiahong · M. Wenlin Department of Cardiology, Tongji Hospital, Tongji University, Shanghai
The influence of hyperhomocysteinemia on left ventricular diastolic function in Chinese patients with hypertension
out Hhcy and 37 hypertensive patients with Hhcy. All data were prospectively collected. Resting blood pressure values were obtained at a physician’s office and echocardiography room by the traditional auscultatory method using a sphygmomanometer. Patients were advised to refrain from smoking, consumption of coffee or tea, and physical exercise 30 min prior to the measurement. Before measurement patients were seated to rest for 5 min. Two separate measurements were averaged to determine office blood pressure. Hhcy was defined as a serum Hcy concentration higher than 10 µmol/l according to the recommendations of the Centers for Diseases Control [7, 9]. Patients with previous coronary artery disease (CAD), diabetes mellitus, hyperuricemia, severe renal dysfunction, left ventricular systolic dysfunction, secondary hypertension, moderate to severe valve disease, atrial fibrillation, symptoms of CAD, and equivalent findings on exercise electrocardiography and perfusion scan, or 24-h rhythm electrocardiography were excluded. All participants gave their informed consent.
Echocardiography Echocardiography was carried out with patients in the left lateral decubitus position with a commercially available system (PHILIPS CX50; Philips ultrasound, Bothell Wash.) using a 2.5–3.5-MHz transducer. All examinations were per-
formed by an experienced cardiologist who had no knowledge of the participant’s clinical information. Early and late mitral inflow velocities ratio (E/A), early diastolic transmitral velocity (E) and early diastolic tissue velocity (e’), late diastolic tissue velocity (a’), isovolumic relaxation time (IVRT), deceleration time (DT), and left ventricular mass (LV mass) were calculated according to 2009 American Society of Echocardiography guidelines. Early and late transmitral inflow velocities and deceleration times were measured by pulsed-wave Doppler from the apical four-chamber view, and medial mitral annular diastolic velocities were measured with tissue Doppler imaging. The medial mitral annular peak systolic velocity and early (e’) and late (a’) diastolic velocities were determined by spectral tissue Doppler imaging at the medial corner of the mitral annulus from the apical four-chamber view using standard methods. The e’ velocity is relatively independent of preload and inversely related to the time constant of isovolumic relaxation. The E/e’ measured by tissue Doppler imaging has gained acceptance as a reliable method for the evaluation of LV diastolic performance and was also used because of its potential advantages over other indices in many cardiac diseases, such as myocardial infarction and heart failure.
Herz 2014
| 1
e-Herz: Original article
Results
Tab. 1 Baseline conditions of patients Characteristics Average age (years) Female sex, n (%) Mean SBP (mmHg) Mean DBP (mmHg) Smoking, n (%) Drinking, n (%) Mean BMI Average disease duration (months) Antihypertensive drugs ACEI/ARB (n) CCB (n) Diuretics (n) β-Blocker (n) Mean serum homocysteine (µmol/l)
Hypertension without Hhcy (n=37) 64.0±7.3 20 (54.1) 131±11.4 80±6.81 10 (27.0) 7 (18.9) 24.0±2.5 127±122 28 20 8 20 8.98±1.55
Hypertension with Hhcy (n=37) 63.9±8.7 17 (45.9) 132±14.0 78±8.96 13 (35.1) 10 (27.0) 23.4±2.3 136±144 27 23 9 19 12.74±2.64
p NS (0.748) NS (0.642) NS (0.229) NS (0.269) NS (0.642) NS (0.442) NS (0.334) NS (0.712) NS (1.000) NS (0.638) NS (1.000) NS (1.000)
e-Herz
Left ventricular (LV) diastolic dysfunction is usually the early finding in patients with hypertension, which can increase the risk of heart failure and cardiovascular mortality, even if at an asymptomatic or preclinical stage but the exact mechanism remains unknown [1, 2, 3, 4, 5, 6]. However, the elevation of homocysteine (Hcy) levels is now known to be an independent risk factor for vascular diseases and high Hcy (Hhcy) levels are more common in Chinese patients with hypertension due to their special genetic background [7]. It can promote oxidant damage to the vascular endothelium, impair endothelium-dependent vasomotor regulation, and may also alter the coagulant properties of the blood [8, 9]. Whether Hhcy has any effect on LV diastolic dysfunction in patients with hypertension has not been clarified as yet. The aim of this study was to assess the influence of Hcy on LV diastolic function in Chinese hypertension patients with Hhcy.
Patients and methods Participants The present study was cross-sectional and observational, including 74 consecutive patients with hypertension who underwent a complete transthoracic echocardiographic examination as well as measurements of E/e’, e’/a’, and other diastolic parameters. The study participants consisted of 37 hypertensive patients with-
L. Ruhui · J. Jinfa · X. Jiahong · M. Wenlin Department of Cardiology, Tongji Hospital, Tongji University, Shanghai
The influence of hyperhomocysteinemia on left ventricular diastolic function in Chinese patients with hypertension
out Hhcy and 37 hypertensive patients with Hhcy. All data were prospectively collected. Resting blood pressure values were obtained at a physician’s office and echocardiography room by the traditional auscultatory method using a sphygmomanometer. Patients were advised to refrain from smoking, consumption of coffee or tea, and physical exercise 30 min prior to the measurement. Before measurement patients were seated to rest for 5 min. Two separate measurements were averaged to determine office blood pressure. Hhcy was defined as a serum Hcy concentration higher than 10 µmol/l according to the recommendations of the Centers for Diseases Control [7, 9]. Patients with previous coronary artery disease (CAD), diabetes mellitus, hyperuricemia, severe renal dysfunction, left ventricular systolic dysfunction, secondary hypertension, moderate to severe valve disease, atrial fibrillation, symptoms of CAD, and equivalent findings on exercise electrocardiography and perfusion scan, or 24-h rhythm electrocardiography were excluded. All participants gave their informed consent.
Echocardiography Echocardiography was carried out with patients in the left lateral decubitus position with a commercially available system (PHILIPS CX50; Philips ultrasound, Bothell Wash.) using a 2.5–3.5-MHz transducer. All examinations were per-
formed by an experienced cardiologist who had no knowledge of the participant’s clinical information. Early and late mitral inflow velocities ratio (E/A), early diastolic transmitral velocity (E) and early diastolic tissue velocity (e’), late diastolic tissue velocity (a’), isovolumic relaxation time (IVRT), deceleration time (DT), and left ventricular mass (LV mass) were calculated according to 2009 American Society of Echocardiography guidelines. Early and late transmitral inflow velocities and deceleration times were measured by pulsed-wave Doppler from the apical four-chamber view, and medial mitral annular diastolic velocities were measured with tissue Doppler imaging. The medial mitral annular peak systolic velocity and early (e’) and late (a’) diastolic velocities were determined by spectral tissue Doppler imaging at the medial corner of the mitral annulus from the apical four-chamber view using standard methods. The e’ velocity is relatively independent of preload and inversely related to the time constant of isovolumic relaxation. The E/e’ measured by tissue Doppler imaging has gained acceptance as a reliable method for the evaluation of LV diastolic performance and was also used because of its potential advantages over other indices in many cardiac diseases, such as myocardial infarction and heart failure.
Herz 2014
| 1
e-Herz: Original article
Results
Tab. 1 Baseline conditions of patients Characteristics Average age (years) Female sex, n (%) Mean SBP (mmHg) Mean DBP (mmHg) Smoking, n (%) Drinking, n (%) Mean BMI Average disease duration (months) Antihypertensive drugs ACEI/ARB (n) CCB (n) Diuretics (n) β-Blocker (n) Mean serum homocysteine (µmol/l)
Hypertension without Hhcy (n=37) 64.0±7.3 20 (54.1) 131±11.4 80±6.81 10 (27.0) 7 (18.9) 24.0±2.5 127±122 28 20 8 20 8.98±1.55
Hypertension with Hhcy (n=37) 63.9±8.7 17 (45.9) 132±14.0 78±8.96 13 (35.1) 10 (27.0) 23.4±2.3 136±144 27 23 9 19 12.74±2.64
p NS (0.748) NS (0.642) NS (0.229) NS (0.269) NS (0.642) NS (0.442) NS (0.334) NS (0.712) NS (1.000) NS (0.638) NS (1.000) NS (1.000)
