الفهرس 
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Abstract
Isolated diastolic dysfunction very often accompanies hypertensive heart disease. Diastolic dysfunction has been found to be common in patients with hypertension even before left ventricular hypertrophy is demonstrable
Doppler indices of left ventricular filling have been used traditionally for the assessment of LV diastolic function. In many circumstances, however, the interpretation of these indices is difficult because they respond to alterations of different physiological variables such as preload, relaxation, and heart rate.
A typical example of their limitation is seen in patients with abnormal LV relaxation and increased preload compensation who often present a pseudonormal LV filling pattern.
Tissue Doppler echocardiography is a new tool that can be used to evaluate diastolic myocardial velocities, which are preload independent. Also allows not only global assessment, but also regional assessment of diastolic function.
The study was carried out in cardiology department, Assiut university hospital.
In this study 40 hypertensive patients (group I) and 15 normotensive persons (group II), with age ranged from 30-50 years, were subjected to:
• Careful history taking.
• Physical examination.
• Twelve-lead ECG.
• Conventional Doppler echocardiography.
• Pulsed wave TDI.
In the current study Sokolow-Lyon criteria were used to define LVH, out of 40 hypertensive patients, 11 had LVH while by echocardiography using penn’s convention 24 cases had LVH (left ventricular mass > 215 grams), which demonstrate the poor sensitivity of ECG for detection of LVH
Assessment of transmitral flow waves by conventional Doppler echocardiography revealed significant reduction of the E wave velocities and E/A ratio in the hypertensive patients in comparison to normotensive group.
With PW-TDI global diastolic function was obtained from mitral annular velocities and showed significant reduction of Em wave velocities and Em/Am ratio in the hypertensive patients compared to normotensive group. Three hypertensive patients showed normal transmitral flow, while by TDI they showed reversed Em/Am ratio, those patients represent the group of pseudonormal diastolic function.
Assessment of regional left ventricular diastolic function by PW-TDI showed significant reduction of the regional Em wave velocities and Em/Am ratio in the hypertensive patients compared to control group. Regional Em wave velocities in the basal segments were higher than those in mid and apical segments both in hypertensive and control groups.
It was found that in all hypertensive group including those with normal global diastolic function, there were regional diastolic dysfunction with variable extension, the higher the prevalence of the myocardial segments involved in diastolic dysfunction, the greater the impairment of the global diastolic function of the left ventricle.
Hypertensive patients with pseudonormal diastolic function had showed the highest percentage of regional diastolic dysfunction.