Respiratory changes in the E/A wave pattern can be an early sign of diastolic dysfunction: An echocardiographic long-term follow-up study

BACKGROUND: The left ventricular filling pattern may show changes during respiration, which are generally used in the diagnosis of diastolic dysfunction. The clinical importance of the respiratory E/A wave pattern change has been investigated in a limited number of studies. The aim of the present study was to assess the diastolic function of hypertensive patients with respiratory changes in mitral flow over a long-term follow-up period. MATERIAL/METHODS: Our study included 107 newly diagnosed and untreated hypertensive patients (49 males; mean age, 46±10 years) with respiratory changes during transthoracic echocardiography (TTE). In addition, the patient group was classified into 2 groups according to the change in E/A pattern by the Valsalva maneuver. After a mean follow-up period of 44±7 month, 90% of the hypertensive patients and the entire control group were re-examined. RESULTS: Relaxation abnormalities developed in 84% of the patients (58/80) in the Valsalva-positive group after the follow-up period. The frequency of relaxation abnormalities was 60% in the Valsalva-negative group and 3.1% in the control group (p<0.001). Based on multivariate regression analysis, the echocardiographic predictors of the development of relaxation impairment were mitral E velocity, A velocity, deceleration time, isovolumetric contraction time, E/E′ ratio, and the presence of respiratory change. The most important parameter for the development of an abnormal relaxation pattern was the presence of respiratory change after adjustment according to the changes with the Valsalva maneuver. CONCLUSIONS: Respiratory change in mitral flow can be evaluated as an early sign of diastolic dysfunction in patients with hypertension.