Abstract 2543: Left Ventricular Diastolic Function in a Broad Range of Patients with Hypertension: The Valsartan in Diastolic Dysfunction (VALIDD) Trial
Background: Progressive diastolic dysfunction is thought to be one of the key physiologic mechanisms linking hypertension and heart failure. There is limited echocardiographic data from community based studies on systolic and diastolic function in asymptomatic hypertensive patients.
Methods: Patients over 45 years old with hypertension and without heart failure were screened at 44 sites in the US and Canada for inclusion in the Valsartan In Diastolic Dysfunction (VALIDD) trial, a multi-center, randomized placebo-controlled double-blind trial assessing the effect of the ARB valsartan on diastolic function using tissue Doppler imaging (TDI).
Results: In 504 hypertensive patients (mean BP 148/85), mitral annular relaxation velocity (Ea) (8.01±2.03 cm/s) declined with age, and was lower than age-specific normal values, although E/Ea was not significantly elevated from normal. Only 3.6% of patients had left ventricular hypertrophy (LVH) by echo or EKG criteria. The LA volume index correlated weakly with E/Ea (r=0.21; p<0.0001). Systolic longitudinal shortening (Sm) was reduced and correlated with Ea (r= 0.42; p<0.0001).
Conclusion: Despite the absence of LVH on either echo or EKG, there is a high prevalence of asymptomatic diastolic dysfunction in the hypertensive population, even in the absence of clinically significant increases in filling pressures. Moreover, longitudinal systolic shortening, measured by longitudinal annular movement, is reduced in this population despite normal left ventricular ejection fraction and fractional shortening.