Impaired left ventricular diastolic function during isometric exercise in asymptomatic patients with hyperlipidaemia
Introduction
Hyperlipidaemia is a recognised major but modifiable risk factor for the development and progression of coronary heart disease and other atherosclerotic conditions [1], [2]. The benefit of reducing cholesterol level in patients with and without established coronary artery disease (CAD) on the prevention of ischaemic manifestations has been well documented [3], [4], [5].
One of the recognised features of ischaemic heart disease is left ventricular (LV) diastolic dysfunction [6], [7], which, precedes systolic dysfunction in the natural history of ischaemic heart disease [7]. Even in the absence of systolic LV dysfunction, diastolic dysfunction of the LV can cause the clinical syndrome of congestive heart failure [8], [9]. Diminished exercise capacity in patients with congestive heart failure and normal systolic LV function has been reported to be the result of impaired diastolic function [10]. As many as one third of patients with heart failure have normal systolic LV function suggesting that diastolic dysfunction is the main pathophysiological mechanism [8], [11]. It is, therefore, important to identify LV diastolic dysfunction at an early stage even prior to the occurrence of systolic dysfunction or appearance of symptoms.
In normal subjects, isometric exercise (IME) has a positive inotropic effect on the heart by causing a rise in systolic and diastolic blood pressure, a small rise in systemic vascular resistance and a moderate rise in heart rate [12], [13]. Similar effects of IME have been reported in patients with hypertension and patients with ischaemic heart disease [14], [15]. IME has been shown to induce LV diastolic dysfunction as determined by Doppler echocardiography in non-diabetic patients with exertional angina and significant coronary artery lesions who have normal LV diastolic function at rest [16]. On the other hand, in healthy individuals or in patients with atypical chest pain but normal coronary arteriogram IME does not induce LV diastolic function [16].
To our knowledge, LV diastolic function has not yet been studied in asymptomatic subjects with hyperlipidaemia. In this report we examined LV diastolic function both at rest and during IME in patients with hyperlipidaemia whom otherwise had no symptoms related to their cardiovascular system.
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Patients and methods
Thirty seven consecutive normotensive patients (20 males and 17 females) with hyperlipidaemia were consecutively recruited from the Lipid Clinic. All had a normal resting ECG, normal fasting blood glucose level and no symptoms or history related to the cardiovascular system. Their ages ranged from 34 to 72 years (mean 54.5±9.8). Other demographic features are shown in Table 1. Twenty eight patients (14 males and 14 females) had type IIa hyperlipidaemia while the other nine were classified as
Results
At rest, no significant difference was found in the E/A between the patients and the volunteers. At peak IME the E/A was significantly lower in the patients than the NOR. This was mainly the result of a higher peak velocity of the active flow resulting from atrial contraction (A) against a lower peak velocity for the early passive flow (E) in the patients than the NOR at peak IME (Table 2). Accordingly, the contribution of the flow due to atrial contraction to the LV filling (ACF) in the
Discussion
We have shown for the first time that LV diastolic function is impaired in asymptomatic normotensive subjects with hypercholesterolaemia but normal fasting glucose level. The diastolic LV abnormalities were revealed by Doppler echocardiography only during IME. These abnormalities were independent of the levels of either total cholesterol, LDL- or HDL-cholesterol and were irrespective of patient's age, gender, family history of cardiovascular disease or smoking habit. Hence hyperlipidaemia is
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