CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 2, March/April 2010
82
AFRICA
Echocardiographic findings
Tables 3 and 4 summarise the echocardiographic parameters.
Except for septal wall thickness and indices of LVsystolic function
(ejection fraction and fractional shortening), which where higher
in men, all the parameters were similar in the men and women.
When the subjects were grouped into those with increased
LV mass (left ventricular hypertrophy) and those with normal
LV mass, significant differences were found in their clinical,
biochemical and echocardiographic characteristics. Hypertensive
subjects with left ventricular hypertrophy were found to be
older, heavier and had higher baseline systolic, diastolic and
mean arterial blood pressures. Their resting heart rate was also
significantly higher. They had higher serum sodium, lower serum
potassium (0.015), higher serum creatinine and higher uric acid
levels. This group also had higher fasting blood glucose and lipid
profiles (total cholesterol, triglycerides and LDL cholesterol).
Accordingly they also had lower mean HDL cholesterol levels.
Comparison of their echocardiographic variables revealed
that subjects with increased LV mass (LVH) had larger aortic
root diameters, left atrial diameters and LV wall thickness. LV
internal dimensions (both in systole and diastole), LV end-
diastolic and end-systolic volumes, stroke volume and cardiac
output were also higher in the group with LVH.
On the other hand, subjects with increased LVM had lower
indices of LV systolic function (ejection fraction and fractional
shortening), relative wall thickness, total peripheral resistance
and pulse pressure–stroke volume ratio. These were all statisti-
cally significant. There was no difference in the indices of LV
diastolic function (E-velocity, A-velocity, E/A ratio and decelera-
tion time).
Determinants of LV mass
As shown in Table 5, LV mass correlated fairly well with
duration of hypertension (
r
=
0.123), alcohol consumption (
r
=
0.209), cigarette smoking (
r
=
0.190), presence of diabetes
mellitus (
r
=
0.187), body weight (
r
=
187) and height (
r
=
TABLE 3. THE ECHOCARDIOGRAPHIC PARAMETERS OF 285 HYPERTENSIVE SUBJECTS SEENAT UCH, IBADAN
Parameter
All subjects
Women
Men
p-value
Aortic root diameter (cm)
2.87
±
0.43
2.84
±
0.40
2.89
±
0.46
0.354
LA (cm)
3.52
±
0.72
3.48
±
0.67
3.56
±
0.76
0.378
Septum (cm)
1.07
±
0.28
1.03
±
0.207
1.11
±
0.33
0.013
PWTd
0.997
±
0.22
0.996
±
0.211
0.998
±
0.228
0.947
LVIDd
4.86
±
0.95
4.84
±
0.91
4.87
±
0.99
0.817
LVIDs
3.34
±
0.96
3.39
±
0.93
3.30
±
0.99
0.457
E-velocity
0.59
±
0.22
1.123
±
0.76
1.03
±
0.70
0.757
A-velocity
0.61
±
0.19
58.7
±
19.8
59.3
±
23.5
0.0806
E/A ratio
1.07
±
0.58
1.02
±
0.46
1.11
±
6.65
0.190
Deceleration time
199.7
±
60.8
196.1
±
61.3
202.5
±
60.5
0.426
LA
=
left atrial diameter, PWTd
=
posterior wall thickness in diastole, LVIDd
=
LV internal diameter in diastole, LVIDs
=
LV internal diameter in
systole, E
=
early left ventricular filling phase, A
=
late left ventricular filling phase.
TABLE 4. THE ECHOCARDIOGRAPHICALLY DERIVED PARAMETERS IN 285 HYPERTENSIVE
MENANDWOMEN SEENAT UCH, IBADAN
Parameter
All subjects
Women
Men
p
- value
LVM
188.7
±
82.4
180.7
±
67.0
195.7
±
93.3
0.124
LVM/height
2.7
50.8
±
22.1
49.6
±
16.6
51.9
±
26.0
0.394
LVM/BSA
116.0
±
49.9
104.2
±
37.3
112.5
±
53.8
0.141
LVM/hypertension
108.6
±
46.9
111.7
±
39.1
119.8
±
57.6
0.172
Relative wall thickness
0.43
±
0.13
0.428
±
0.13
0.428
±
0.14
0.985
LVH/no LVH
111/174
58/74
53/100
0.145
Fractional shortening (%)
32.0
±
9.2
30.7
±
9.96
33.0
±
8.75
0.033
Ejection fraction (%)
58.9
±
13.4
57.0
±
14.2
60.5
±
12.6
0.027
End-diastolic volume (ml)
116.6
±
54.9
115.3
±
50.6
117.7
±
58.4
0.711
End-systolic volume (ml)
51.5
±
38.7
52.6
±
36.4
50.5
±
40.6
0.651
Stroke volume (ml)
65.2
±
25.7
62.7
±
25.2
67.2
±
26.1
0.140
Stroke index (ml/m
2
)
1.74
±
0.18
1.735
±
0.191
1.751
±
0.162
0.428
Cardiac output (ml)
5275
±
2636
5192
±
2606
5348
±
2669
0.623
Cardiac index (ml/m
2
)
3.04
±
1.50
300.94
±
1472.2
3072.8
±
152.40
0.725
Total peripheral resistance (dynes/ml)
0.027
±
0.015
0.027
±
0.16
0.026
±
0.013
0.497
Pulse pressure–stroke volume ratio
1.07
±
0.73
1.13
±
0.75
1.03
±
0.70
0.247
Wall stress (dynes/cm
2
)
338.6
±
119.9
335.9
±
106.0
340.9
±
131.0
0.724
Wall tension (dynes/cm
2
)
186.5
±
75.9
181.7
±
68.3
190.7
±
82.0
0.319
LVM
=
left ventricular mass, LVH
=
left ventricular hypertrophy, BSA
=
body surface area.
