Subscribe to RSS
DOI: 10.1055/s-2005-865063
© Georg Thieme Verlag Stuttgart · New York
Gestörte Dehnbarkeit des Hochdruckherzens unter Belastung als früher Marker einer diastolischen Dysfunktion
Reduced left ventricular distensibility as an early sign of diastolic dysfunction in hypertensive heart diseasePublication History
eingereicht: 24.8.2004
akzeptiert: 3.2.2005
Publication Date:
10 March 2005 (online)

Zusammenfassung
Fragestellung: Patienten mit arterieller Hypertonie klagen häufig über eine belastungsassoziierte Dyspnoe. Es ist unklar, ob eine systolische, eine früh- oder eine spätdiastolische Funktionsstörung ursächlich ist.
Methodik: Unsere Untersuchung schloss 21 hypertensive Patienten (7 Frauen, 14 Männer, Altersmedian 56 Jahre) und 12 normotensive Patienten (4 Frauen, 8 Männer, Altersmedian 52 Jahre) ein, bei denen eine koronare Makroangiopathie ausgeschlossen wurde. Mittels Herzbinnenraumszintigraphie und Einschwemmkatheter wurden Parameter der systolischen und diastolischen Herzfunktion in Ruhe und unter Belastung analysiert.
Ergebnisse: Beide Kollektive zeigten unter Belastung eine normale Ejektionsfraktion (Hochdruckpatienten 71 % ± 10; Kontrollgruppe 72 % ± 11). Hochdruckpatienten zeigten unter Belastung einen Anstieg des pulmonalkapillaren Verschlussdrucks (17,4 ± 8 vs 11,5 ± 5 mmHg; p = 0,005), ein fixiertes enddiastolisches Ventrikelvolumen (82 ± 21 vs 104 ± 23 ml/m2 p = 0,01) und ein reduziertes Schlagvolumen (58 ± 1,2 vs 73 ± 1,4 ml/m 2; p = 0,007). Füllungsdynamisch zeigten sich im Vergleich zum Normalkollektiv Hinweise für einen forcierten frühdiastolischen Einstrom („peak filling rate” = 6,1 ± 1,6 vs 4,8 ± 1,8 EDV/s; p = 0,04). Dieser könnte Folge einer Übertragung systolischer Energie in die frühe Diastole sein und zum Erhalt der Belastungskapazität des Hochdruckkollektivs beigetragen haben (Herzindex = 8,1 ± 1,8 vs 8,4 ± 2,2 l/min × m 2; ns).
Folgerung: Eine erhöhte Steifigkeit des Herzens unter Belastung ist eine Frühmanifestation des Hochdruckherzens.
Summary
Background: Hypertensive patients often present with exertional dyspnoe. However it is questioned whether it results from a systolic, early- or late diastolic impairment of left ventricular function.
Patients and methods: Our study included 21 hypertensive patients (7 female; 14 male, median age 56 years) and 12 controls (4 female; 8male, median age 52 years). All patients had normal epicardial coronary arteries. Parameters of systolic and diastolic heart function at rest and during exercise were analyzed using a combined hemodynamic and radionuclidangiographic approach.
Results: One principal finding was that the investigated hypertensive patients had a normal ejection fraction during exercise (72 % ± 11 vs 71 % ± 10 in the control group). However these patients showed an exercise induced increase of pulmonary capillary wedge pressure (17,4 ± 8 vs 11,5 ± 5; p = 0,005), a fixed enddiastolic volume (82 ± 21 vs 104 ± 23 ml/m 2 p = 0,01) and a reduced stroke volume index (58 ± 1,2 vs 73 ± 1,4 ml/m 2; p = 0,007). Radionuclid angiography revealed an increased exercise peak filling rate (6,1±1,6 vs 4,8±1,8 EDV/s; p = 0,04) in hypertensive patients. We assume that exercise capacity (cardiac index = 8,1 ± 1,8 vs 8,4 ± 2,2 l/min × m 2; ns) in hypertensive patients without excessive LV hypertrophy is predominantly preserved by an enhanced contractile state and its favorable effects on early diastolic filling.
Conclusion: An increased left ventricular stiffness during exercise is an early manifestation of hypertensive heart disease.
Literatur
- 1
Carroll J D, Hess O M, Hirzel H O, Krayenbuehl H P.
Dynamics of left ventricular filling at rest and during exercise.
Circulation.
1983;
68
59-67
MissingFormLabel
- 2
Courtois M C, Mechem C J, Barzilai B, Ludbrook P A.
Factors related to end-systolic volume are important determinants of peak early diastolic
transmitral flow velocity.
Circulation.
1992;
85
1132-1138
MissingFormLabel
- 3
Cuocolo A, Sax F L, Brush J E, Maron B J, Bacharach S L, Bonow R O.
Left ventricular hypertrophy and impaired diastolic filling in essential hypertension:
Diastolic mechanisms for systolic dysfunction during exercise.
Circulation.
1990;
81
978-986
MissingFormLabel
- 4
Devereux R B, Reichek N.
Echocardiographic determination of left ventricular mass in man.
Circulation.
1977;
55
613-618
MissingFormLabel
- 5
Fouad-Tarazi F M.
Radionuclide ventriculography in the assessment of diastolic function in hypertension.
Herz.
1990;
15
393-298
MissingFormLabel
- 6
Franz I W, Tönnesmann U, Erb D.
Exercise hemodynamic in hypertensive patients with microvascular angina, coronary
artery disease and without ischemic syndrome-effect of nifedipine.
Z Kardiol.
1997;
86
936-944
MissingFormLabel
- 7
Inagaki M, Yokota M, Izawa H. et al .
Impaired force-frequency relations in patients with hypertensive left ventricular
hypertrophy.
Circulation.
1999;
99
1822-1830
MissingFormLabel
- 8
Inouye I, Massie B, Loge D. et al .
Abnormal left ventricular filling: An early finding in mild to moderate systemic hypertension.
Am J Cardiol.
1984;
53
120-126
MissingFormLabel
- 9
Ishida Y I, Meisner J S, Tsuijoka K. et al .
Left ventricular filling dynamics: influence of left ventricular relaxation and left
atrial pressure.
Circulation.
1986;
74
187-196
MissingFormLabel
- 10
Kapuku G K, Seto S, Mori H. et al .
Impaired left ventricular filling in borderline hypertensive patients without cardiac
structural changes.
Am Heart J.
1993;
125
1710-1715
MissingFormLabel
- 11
Kaski J C.
Myocardial ischaemia in the hypertensive patient-the role of coronary microcirculation
abnormalities.
Eur Heart J.
1993;
14
32-37
(Suppl J)
MissingFormLabel
- 12
Kitzman D W, Higginbotham M B, Cobb F R, Sheikh K H, Sullivan M J.
Exercise intolerance in patients with heart failure and preserved left ventricular
systolic function: Failure of the Frank-Starling Mechanism.
J Am Coll Cardiol.
1991;
17
1065-1072
MissingFormLabel
- 13
Lenihan D J, Gerson M C, Dorn G W, Hoit B D, Walsh R A.
Effects of changes in atrioventricular gradient and contractility on left ventricular
filling in human diastolic cardiac dysfunction.
Am Heart J.
1996;
132
1179-1188
MissingFormLabel
- 14
Lim P O, MacFadyen J M, Clarkson P BM, MacDonald T M.
Impaired exercise tolerance in hypertensive patients.
Ann Intern Med.
1996;
124
41-55
MissingFormLabel
- 15
Liu C P, Ting C T, Lawrence W, Maughan W L, Chang M S, Kass D A.
Diminished contractile response to increased heart rate in intact human left ventricular
hypertrophy: systolic versus diastolic determinants.
Circulation.
1993;
88
1893-1906
MissingFormLabel
- 16
Mureddu G F, de Simone G, Greco R, Rosato G F, Contaldo F.
Left ventricular filling in arterial hypertension: Influence of obesity and hemodynamic
and structural confounders.
Hypertension.
1997;
29
544-550
MissingFormLabel
- 17
Randhawa A K, Singal P K.
Pressure overload-induced cardiac hypertrophy with and without dilatation.
J Am Coll Cardiol.
1992;
20
1569-1575
MissingFormLabel
- 18
Schwartzkopff B, Brehm M, Mundhenke M, Strauer B E.
Repair of coronary arterioles after tratment with perindopril in hypertensive heart
disease.
Hypertension.
2000;
36
220-225
MissingFormLabel
- 19
Schwartzkopff B, Mundhenke M, Strauer B E.
Arterielle Hypertonie und Herzinsuffizienz.
Internist.
2000;
41
253-260
MissingFormLabel
- 20
Schwartzkopff B, Stark P, Schulte H D. et al .
Early changes in systolic and diastolic function at rest and under exercise in patients
with hypertrophic cardiomyopathy after myectomy.
Z Kardiol.
1997;
86
438-449
MissingFormLabel
- 21
Schwartzkopff B, Strauer B E.
Coronary reserve and Arteriosclerosis in hypertensive heart disease.
Z Kardiol.
2000;
89
(Suppl 9)
132-135
MissingFormLabel
- 22
Schwartzkopff B, Motz W, Frenzel H, Vogt M, Knauer S, Strauer B E.
Structural and functional alterations of the intramyocardial coronary arterioles in
patients with arterial hypertension.
Circulation.
1993;
88
993-1003
MissingFormLabel
- 23
Smith V E, Schulman P, Karemeddini M K, White W B, Meeran M K, Katz A.
Rapid ventricular filling in left ventricular hypertrophy.
J Am Coll Cardiol.
1985;
5
869-874
MissingFormLabel
- 24
Sung B H, Lovallo W R, Teague S M, Pincomb G A, Wilson M F.
Cardiac adaptation to increased systemic blood pressure in borderline hypertensive
men.
Am J Cardiol.
1993;
72
407-412
MissingFormLabel
- 25
Udelson J E, Bacharach S L, Cannon R O, Bonow R O.
Minimum left ventricular pressure during β-adrenergic stimulation in human subjects.
Evidence for elastic recoil and diastolic „suction” in the normal heart.
Circulation.
1990;
82
1174-1182
MissingFormLabel
Dr. med. Gunnar Plehn
Medizinische Klinik II, Kardiologie/ Angiologie, Marienhospital Herne, Universitätsklinik
der Ruhr-Universität Bochum
Hölkeskampring 40
44625 Herne
Phone: 02323/4991601
Fax: 02323/499301
Email: gplehn@gmx.de