Left Ventricular Diastolic Dysfunction in Patients with Turner’s Syndrome

Objectives: Turner’s syndrome (TS) is associated with multiple cardiovascular risk factors that have a potential impact on left ventricular (LV) diastolic function. This study aimed to assess LV diastolic function in patients with TS through tissue Doppler imaging.

Methods: Thirty-nine asymptomatic patients with TS and 19 healthy, age-matched controls were prospectively recruited for this study. LV diastolic performance was conventionally evaluated through Doppler assessed mitral inflow velocities (E [cm/s], A [cm/s]). From an apical four-chamber view, tissue Doppler imaging was performed at the lateral LV wall and the interventricular septum (IVS) at a frame rate >200/s. For each segment, myocardial velocities (S′ [cm/s], E′ [cm/s], A′ [cm/s]) were measured offline. Early mitral inflow velocity (E [cm/s]) was subsequently put in relation to E′. Additionally, ratios were calculated for E to E′ average ([E′LV+ E′IVS]/2) and E to A.

Results: Compared with the control group, TS patients showed significantly higher ratios for E/E′LV (6.04 ± 1.25 vs. 5.10 ± 0.78, p = 0.002), E/E′IVS (7.44, 3.80–18.17 vs. 6.46, 4.83–7.73, p = 0.003), E/E′ average (6.68 ± 1.42 vs. 5.60 ± 0.69, p = 0.001) and a significantly lower E/A ratio (1.49 ± 0.33 vs. 1.78 ± 0.45, p = 0.008). Moreover, TS patients had a significantly higher resting heart rate (85.14 ± 15.08 vs. 67.05 ± 11.78, p = 0.001). Among all individuals studied, the E/A ratio correlated inversely with resting heart rate (r = −0.513, p < 0.001) and the diastolic blood pressure (r = −0.380, p = 0.004). The diastolic parameters measured did not correlate with systolic blood pressure, height, weight, body mass index, or diabetic status as reflected by HbA1C level.

Conclusion: Our study demonstrated that asymptomatic TS patients had altered LV diastolic relaxation and significantly higher LV filling pressures. We therefore recommend the inclusion of tissue Doppler imaging in the current echocardiographic screening of TS patients to detect subtle LV diastolic dysfunction. To what extent the significantly higher resting heart rate in the TS patients, we examined had an impact on LV diastolic dysfunction remains uncertain. Future studies are required to further investigate the relation between LV diastolic dysfunction and elevated resting heart rate in patients with TS.