Assessment of diastolic function in arterial hypertension - the role of echocardiography

Abstract

Diastolic dysfunction is a common pattern found in about 30–50% of patients with arterial hypertension and precedes morphological changes (left ventricular hypertrophy, cardiac enlargement). It is caused by left ventricular hypertrophy, ischemia and dysfunction of microcirculation, neurohormonal activation, systolic and diastolic desynchrony, and hemodynamic factors connected with increased preload and afterload. There are 3 stages of diastolic dysfunction differentiated on the basis of mitral diastolic flow pattern: prolonged relaxation, pseudonormalisation and restriction. Apart from the classical parameters there are new, especially helpful in differentiation of pseudonormal pattern i.e. tissue Doppler echocardiographic parameters, mitral inflow propagation, Tei index. Diastolic function should be always assessed in patients with hypertension providing additional diagnostic, therapeutic and prognostic information.