• Omed Hamakarem Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Kamaran Hassan Kurdistan Board of Medical Specialties Candidate, Erbil, Kurdistan Region, Iraq.
  • Dana Mohammed Saeed Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.



Hypertension, 2D echocardiography, Diastolic dysfunction, Heart failure



Diastolic dysfunction refers to when the diastole part is abnormal. The ventricles do not properly relax and become stiff meaning they cannot fill with blood properly. This causes blood to “dam up” in other parts of the body. The pressure in the ventricles then increases as blood from the next heartbeat tries to enter. Diastolic dysfunction is a common problem, with many people aged older than 70 years having the condition


To detect subclinical left ventricular diastolic dysfunction in hypertensive patients with preserved ejection fraction using 2D echocardiography.


This is a cross-sectional study that was carried on 80 hypertensive patients referred to slemani cardiac hospital and medical emergency outpatient clinic for evaluation and treatment of hypertension and 80 age and sex-matched healthy volunteers as a control group. All subjects underwent conventional echocardiographic examination and assessment of diastolic dysfunction by 2D echocardiography according to updated Europian guidelines for diastolic dysfunction


A total of one hundred sixty (160) individuals were included in the final analysis. Mean age was 55.03±7.67SD years. Males accounted for 51.9% (n=83) of the studied sample and 48.1% (n=77) were females. Fifty percent (n=80) were hypertensive (cases) and the other 50% (n=80) were non-hypertensive (controls).hypertensive patients have significantly higher rates of diastolic dysfunction (22 cases vs 12) and LVH (19 vs 5) than non-hypertensives, they also have higher mean lateral annulus velocity (8.83±2.41vs10.21±2.62 ) and TR velocity(2.28±0.37vs2.11±0.11) but smaller mean LA volume.


Impairment of diastolic function detected by 2D echocardiography was significantly higher in hypertensive patients (with and without LVH) compared to nonhypertensive patients. Early detection of diastolic dysfunction in hypertensive patients is necessary to prevent diastolic heart failure which is the major type of heart failure in hypertensive patients.


Kearney PM; Whelton M et al, Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365:217-23 DOI:

Kearney PM, et al. Worldwide prevalence of hypertension: a systematic review. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA. 2004 Jan; 22(1):11

Vasan RS et al Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham heart study. JAMA 2002; 287:1003-10] DOI:

Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, Marino P, Smiseth OA, De Keulenaer G, Leite-Moreira AF, Borbély A, Edes I, Handoko ML, Heymans S, Pezzali N, Pieske B, Dickstein K, Fraser AG, Brutsaert DL. How to diagnose heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007; 28: 2539–2550. DOI:

Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini D, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW: ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. A report of the American College of Cardiology/American Heart Association Task Force on practical guidelines. 2005.

.European Study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. European Heart Journal, 1998; 19:990-1003. DOI:

Thomas JD, Garcia MJ, Greenberg NL. Application of color Doppler M-mode echocardiography in the assessment of ventricular diastolic function: potential for quantitative analysis. Heart Vessels 1997; 12(suppl) 135-137.

Adebiyi AA, Aje A, Ogah OS, et al. Left ventricular function parameters in Hypertensives. J Natl Med Assoc. 2005 97(1)41-5.

Zile MR; Baicu CF; Bonnema D. Diastolic heart failure: definitions and terminology; Prog Cardiovasc Dis. 2005 Mar-Apr;47(5):307-13 DOI:

Rohde LE; Palombini DV; Polanczyk CA; Goldraich LA; Clausell N A. Hemodynamically oriented echocardiography-based strategy in the treatment of congestive heart failure. J Card Fail. 2007 Oct;13(8):618-25 DOI:

Fischer M, et al, Prevalence of left ventricular diastolic dysfunction in the community: Results from a Doppler echocardiographic-based survey of a population sample.Eur Heart J 2003; 24: 320-328. DOI:

Vasan RS; Benjamin EJ; Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective.J Am Coll Cardiol 1995 Dec;26(7):1565-74 failure of the Frank Starling mechanism. DOI:

Thomas JD, Garcia MJ, Greenberg NL. Application of color Doppler M-mode echocardiography in the assessment of ventricular diastolic function: potential for quantitative analysis. Heart Vessels 1997; 12(suppl) 135-137

Du Bois D, Du Bois EF (1989) A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition 5: 303-311.

Whelton pk, et al.2017 High blood pressure guideline.journal of American college of cardiology .2017;11.006

Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging 2015;16:1031-41 DOI:

Young Investigator's Award Winner: Assessment of diastolic function in newly diagnosed hypertensives. Masliza M, Daud SM, Khalid. Ann Acad Med Singapore. 2005 Dec; 34(11):684-5

Kingue S, Mbango GF, Ouankou M. Echocardiographic study of left ventricular hypertrophy in 98 black hypertensives. Trop Cardiol. 1993;19:51–55.

Slama M, Music D, Varagic J, Frohlich ED. Diastolic dysfunction in hypertension. Curr Opin Cardiol. 2002;17:368–373. DOI:

Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, Di Tullio MR. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol. 2011;57:1368–1374. DOI:

Bae HK, Choi HS, Sohn S, Shin HJ, Nam JH, Hong YM. Cardiovascular screening in asymptomatic adolescents with metabolic syndrome. J Cardiovasc Ultrasound. 2015;23:10–19. DOI:

Loehr LR, Rosamond WD, Poole C, McNeill AM, Chang PP, Folsom AR, Chambless LE, Heiss G. Association of multiple anthropometrics of overweight and obesity with incident heart failure: the Atherosclerosis Risk in Communities study. Circ Heart Fail. 2009;2:18–24. DOI:

Ávila-Vanzzini N, Machain Leyva CZ, Rodríguez Castellanos LE, Arias Godínez JA, Ruiz Esparza ME, Herrera Bello H. Excessive weight and obesity are associated to intra-ventricular asynchrony: pilot study. J Cardiovasc Ultrasound. 2015;23:86–90. DOI:

Kossaify A, Nicolas N. Impact of overweight and obesity on left ventricular diastolic function and value of tissue Doppler echocardiography. Clin Med Insights Cardiol. 2013;7:43–50. DOI:

Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3:141–146. DOI:

Chang CJ, Wu CH, Chang CS, Yao WJ, Yang YC, Wu JS, Lu FH. Low body mass index but high percent body fat in Taiwanese subjects: implications of obesity cutoffs. Int J Obes Relat Metab Disord. 2003;27:253–259. DOI:

Zile MR, Gottdiener JS, Hetzel SJ, McMurray JJ, Komajda M, McKelvie R, et al., Investigators IP. Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation 2011;124:2491-501 DOI:

Shah AM, Claggett B, Sweitzer NK, Shah SJ, Anand IS, O’Meara E, et al. Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial. Circ Heart Fail 2014;7:740-51 DOI:



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