Wiener klinische Wochenschrift

, Volume 119, Issue 13–14, pp 423–427 | Cite as

Left ventricle diastolic dysfunction in obese patients with newly diagnosed arterial hypertension

  • Viktor Persic
  • Alen Ruzic
  • Bojan MileticEmail author
  • Sanja Balen
  • Zeljko Jovanovic
  • Aleksandar Vcev
  • Sanjin Racki
  • Bozidar Vujicic
Original Article


BACKGROUND: The frequent coexistence of obesity and arterial hypertension is well known. Although both conditions have been identified as independent risk factors for impaired left ventricular diastolic function, there is a paucity of data on the dysfunction among obese patients with newly diagnosed arterial hypertension. The study was performed to determine the prevalence of diastolic dysfunction in obese individuals with newly diagnosed arterial hypertension and to compare it with the prevalence in normotensive obese persons. METHODS: We enrolled 125 obese patients: 65 with newly diagnosed hypertension and 60 normotensive patients matched for age, sex and body mass index. Left ventricular diastolic function was assessed from the following Doppler-echocardiographic measurements: mitral inflow velocities (E and A wave), E wave deceleration time, isovolumetric relaxation time, left atrial and left ventricular diameters, left ventricular wall thickness and left ventricular heart mass index. Diastolic dysfunction was considered when the E/A ratio was <1. RESULTS: We found significantly higher A wave, lower E/A ratio, longer E deceleration time and a bigger left atrium in obese patients with newly diagnosed arterial hypertension. We did not find significant differences in E wave peak velocities between the two groups. Although there was no difference in left ventricle heart mass or the prevalence of left ventricle hypertrophy, the prevalence of diastolic dysfunction was higher in the group with newly diagnosed arterial hypertension. CONCLUSION: This study suggests that newly diagnosed arterial hypertension significantly contributes to impairment of left ventricular diastolic function in obese patients before development of structural aberrations detectable on echocardiography.


Newly diagnosed arterial hypertension Obesity Left ventricle diastolic function Echocardiography Left ventricle abnormal relaxation 

Linksventrikuläre diastolische Dysfunktion bei adipösen Patienten mit neu diagnostizierter arterieller Hypertonie


HINTERGRUND: Arterielle Hypertonie und Adipositas sind als unabhängige Risikofaktoren der linksventrikulären diastolischen Dysfunktion schon lange bekannt; ebenso bekannt ist die häufige Koexistenz von arterieller Hypertonie und Adipositas. Daten über die linksventrikuläre diastolische Dysfunktion bei adipösen Patienten mit neu diagnostizierter arterieller Hypertonie gibt es allerdings bisher nur wenige. Diese Studie wurde durchgeführt, um die Prävalenz der linksventrikulären diastolischen Dysfunktion bei adipösen Patienten mit neu diagnostizierter arterieller Hypertonie zu erheben. METHODEN: 125 adipöse Patienten wurden in unsere Studie einbezogen, davon 65 mit neu diagnostizierter arterieller Hypertonie. Alter, Geschlecht und Body Mass Index der Hypertoniker waren mit der Gruppe der 60 adipösen Nicht-Hypertoniker vergleichbar. Die linksventrikuläre diastolische Funktion wurde mittels Doppler-Echokardiographie durch Messung folgender Parameter erhoben: Geschwindigkeit des Mitral-Influx (E- und A-Welle), E-Wellen-Dezelerationszeit, isovolumetrische Relaxationszeit, linksatriale und linksventrikuläre Diameter, intraventrikuläre Septumdicke und linksventrikuläre Herzmasse. Ein E/A-Verhältnis <1 wurde als diastolische Dysfunktion aufgefasst. ERGEBNISSE: Bei neu diagnostizierten adipösen Hypertonikern wurden signifikant höhere A-Wellen, signifikant niedrigere E/A Verhältnisse, signifikant längere E-Wellen-Dezelerationszeiten und signifikant größere linke Vorhöfe gefunden. Die Spitzengeschwindigkeit der E-wellen unterschied sich nicht signifikant. Auch in der Prävalenz der linksventrikulären Hypertrophie und der linksventrikulären Herzmasse wurde kein signifikanter Unterschied gefunden. Die Prävalenz der diastolischen Dysfunktion war bei den adipösen Patienten mit neu diagnostizierter arterieller Hypertonie signifikant häufiger. KONKLUSION: Die Studie weist auf einen signifikanten Beitrag der neu diagnostizierten arteriellen Hypertonie zur Verschlechterung der diastolischen Funktion des linken Ventrikels bei adipösen Patienten – noch vor dem Nachweis struktureller Änderungen – hin.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Fischer M, Baessler A, Hense HW, Hengstenberg C, Muscholl M, Holmer S, et al (2003) Prevalence of left ventricular diastolic dysfunction in the community. Eur Heart J 24: 320–328PubMedCrossRefGoogle Scholar
  2. Bozic I, Polic S, Rakic D, Carevic V (2006) Doppler echocardiographic assessment of diastolic function of left ventricle. Lijec Vjesn 128: 153–161PubMedGoogle Scholar
  3. de Carvalho Frimm C, Soufen HN, Koike MK, Pereira VF, Curi M (2005) The long-term outcome of patients with hypertensive cardiomyopathy. J Hum Hypertens 19: 393–400PubMedCrossRefGoogle Scholar
  4. Oberkofler H, Krempler F, Patsch W (2002) Pathophysiology and genetics of obesity. Wien Klin Wochenschr 114 [Suppl 4]: 4–9PubMedGoogle Scholar
  5. Bella JN, Palmieri V, Kitzman DW, Liu JE, Oberman A, Hunt SC, et al (2002) Gender difference in diastolic function in hypertension (The HyperGEN Study). Am J Cardiol 89: 1052–1056PubMedCrossRefGoogle Scholar
  6. Zabalgoitia M, Rahman U, Noor S, Haley WE, Abochamh DA, Oneschuk L, et al (1997) Role of left ventricular hypertrophy in diastolic dysfunction in aged hypertensive patients. J Hypertens 15: 1175–1179PubMedCrossRefGoogle Scholar
  7. Saner H (2003) From cardiac rehabilitation to prevention. Wien Klin Wochenschr 115: 743–744PubMedCrossRefGoogle Scholar
  8. Balci B, Yilmaz O (2002) Influence of left ventricular geometry on regional systolic and diastolic function in patients with essential hypertension. Scand Cardiovasc J 36: 292–296PubMedCrossRefGoogle Scholar
  9. Adebiyi AA, Aje A, Ogah OS, Ojji DB, Oladapo OO, Falase AO (2005) Left ventricular diastolic function parameters in hypertensives. J Natl Med Assoc 97: 41–45PubMedGoogle Scholar
  10. Abhayaratna WP, Marwick TH, Smith WT, Becker NG (2006) Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey. Heart 92: 1259–1264PubMedCrossRefGoogle Scholar
  11. Roldan C (2005) Ventricular diastolic dysfunction. In: Roldan C (ed) The ultimate ECHO guide. Lippincott Williams & Wilkins, Philadelphia, pp 56–70Google Scholar
  12. Petek Ster M, Kersnik J (2005) Knowledge and acceptance of hypertension guidelines in clinical practice: Experience from Slovenia. Wien Klin Wochenschr 117: 534–540PubMedCrossRefGoogle Scholar
  13. Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58: 1072–1083PubMedGoogle Scholar
  14. European Study Group on Diastolic Heart Failure (1998) How to diagnose diastolic heart failure. Eur Heart J 98: 2282–2289Google Scholar
  15. Ebinc H, Ebinc FA, Ozkurt ZN, Dogru T, Yimaz M (2006) Relationship of left ventricular mass to insulin sensitivity and body mass index in healthy individuals. Acta Cardiol 61: 398–405PubMedCrossRefGoogle Scholar
  16. Di Bello V, Santini F, Di Cori A, Pucci A, Palagi C, Delle Donne M, et al (2006) Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study. Int J Obes (Lond) 30: 948–956CrossRefGoogle Scholar
  17. Haji SA, Ulusoy RE, Patel DA, Srinivasan SR, Chen W, Delafontaine P, et al (2006) Predictors of left ventricular dilatation in young adults (from the Bogalusa Heart Study). Am J Cardiol 98: 1234–1237PubMedCrossRefGoogle Scholar
  18. Smalcelj A, Puljevic D, Buljevic B, Brida V (2000) Left ventricular hypertrophy in obese hypertensives: is it really eccentric? (An echocardiographic study). Coll Antropol 24: 167–183PubMedGoogle Scholar
  19. Kirk-Gardner R, Crossman J (1991) Cardiac risk factors of smoking, hypertension, obesity and family history: a review of the literature. Can J Cardiovasc Nurs 2: 9–14PubMedGoogle Scholar
  20. Powell BD, Redfield MM, Bybee KA, Freeman WK, Rihal CS (2006) Association of obesity with left ventricular remodeling and diastolic dysfunction in patients without coronary artery disease. Amer J Cardiol 98: 116–120PubMedCrossRefGoogle Scholar
  21. McKee PA, Castelli WP, McNamara PM, Kannel NB (1971) The natural history of congestive heart failure: the Framingham Study. N Engl J Med 285: 1441–1446PubMedCrossRefGoogle Scholar
  22. Masliza M, Mohd Daud S, Khalid Y (2005) Assessment of diastolic function in newly diagnosed hypertensives. Ann Acad Med Singapore 34: 684–688PubMedGoogle Scholar
  23. Palatini P, Frigo G, Vriz O, Bertolo O, Dal Follo M, Daniele L, et al (2001) Early signs of cardiac involvement in hypertension. Am Heart J 142: 1016–1023PubMedCrossRefGoogle Scholar
  24. Andersen NH, Poulsen SH, Helleberg K, Ivarsen P, Knudsen ST, Mogensen CE (2003) Impact of essential hypertension and diabetes mellitus on left ventricular systolic and diastolic performance. Eur J Echocardiogr 4: 306–312PubMedCrossRefGoogle Scholar
  25. Verdecchia P, Schillaci G, Guerrieri M, Boldrini F, Gatteschi C, Benemio G (1990) Prevalence and determinants of left ventricular diastolic filling abnormalities in an unselected hypertensive population. Eur Heart J 11: 679–691PubMedGoogle Scholar
  26. Aydin M, Ozeren A, Bilge M, Atmaca H, Unalacak M, Dursun A, et al (2005) Left ventricular diastolic function and circadian variation. Tex Heart Inst J 32: 28–34PubMedGoogle Scholar
  27. Grandi AM, Zanzi P, Piantanida E, Gaudio G, Bertolini A, Guasti L, et al (2000) Obesity and left ventricular diastolic function: noninvasive study in normotensives and newly diagnosed never-treated hypertensives. Int J Obes Relat Metab Disord 24: 954–958PubMedCrossRefGoogle Scholar
  28. Parrinello G, Licata A, Colomba D, Di Chiara T, Argano C, Bologna P, et al (2005) Left ventricular filling abnormalities and obesity-associated hypertension: relationship with overproduction of circulating transforming growth factor beta 1. J Hum Hypertens 19: 543–550PubMedCrossRefGoogle Scholar
  29. Otto ME, Belohlavek M, Khandheria B, Gilman G, Svatikova A, Somers V (2004) Comparison of right and left ventricular function in obese and nonobese men. Am J Cardiol 93: 1569–1572PubMedCrossRefGoogle Scholar
  30. Mercadier JJ, De la Bastie D, Menasche P, N'Guyen Van Cao A, Bouveret P, Lorente P, et al (1987) Alpha-myosin heavy chain isoform and atrial size in patients with various types of mitral valve ventricular dysfunction: a quantitative study. J Am Coll Cardiol 9: 1024–1030PubMedCrossRefGoogle Scholar
  31. Di Bello V, Santini F, Di Cori A, Pucci A, Palagi C, Delle Donne MG, et al (2006) Obesity cardiomyopathy: is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr 19: 1063–1071PubMedCrossRefGoogle Scholar
  32. Appleton CP, Galloway JM, Gonzales MS, Gaballa M, Basnight MA (1993) Estimation of left ventricular filling pressure using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the differences in duration of pulmonary venous and mitral flow velocity at atrial contraction. J Am Coll Cardiol 22: 1972–1982PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Viktor Persic
    • 1
  • Alen Ruzic
    • 1
  • Bojan Miletic
    • 1
    Email author
  • Sanja Balen
    • 2
  • Zeljko Jovanovic
    • 1
  • Aleksandar Vcev
    • 3
  • Sanjin Racki
    • 4
  • Bozidar Vujicic
    • 5
  1. 1.Department of CardiologyThalassotherapia OpatijaCroatia
  2. 2.Department of TransfusiologyClinical Hospital Center RijekaCroatia
  3. 3.Clinic for Internal MedicineClinical Hospital OsijekCroatia
  4. 4.Clinic for Internal MedicineClinical Hospital Center RijekaCroatia
  5. 5.Health Center UmagCroatia

Personalised recommendations