Congestive heart failure in patients with systemic hypertension : a retrospective analysis with gated bloodpool scintigraphy

Abstract

Congestive heart failure (CHF) is a clinical syndrome that may be a manifestation of inadequate myocardial contraction (myocardial failure), volume overload or inadequate ventricular filling. In the Framingham Heart Study in participants aged 40 to 89 years and free of chronic heart failure, Levy, Larson, Vasan, Kannel & Ho (1996:1560) found a substantially greater risk for the development of CHF in both hypertensive men and women. The reason for CHF was not established i.e. systolic or diastolic dysfunction or both. More recently the effect of hypertensive left ventricular hypertrophy on left ventricular systolic function was reported in the Losartan Intervention for Endpoint (LIFE) study (Wachtell, Rokkedal, Bella, Aalto, Dahlöf, Smith, Roman, Ibsen, Aurigemma & Devereux, 2001:57). The left ventricular ejection fraction (LVEF) remains normal in most patients with left ventricular hypertrophy, but abnormal diastolic left ventricular filling in patients with high left ventricular mass was reported. The purpose of this study was to analyze the prevalence of systolic and diastolic dysfunction (or both) by means of radionuclide bloodpool scintigraphy in patients with the clinical diagnosis of hypertensive heart failure, referred to the Nuclear Medicine Department, Universitas Hospital, Bloemfontein. The LVEF did not differ significantly between the two groups, and remain within normal limits, but the mean PFR and TPF differ significantly between the two groups, indicating diastolic dysfunction in the study group. The differentiation between systolic and diastolic dysfunction has become of utmost importance because of differences in the therapeutic approach to congestive heart failure. Conventional treatment of heart failure with vasodilators, digitalis and diuretics, is irrelevant and even dangerous with diastolic dysfunction, and must be treated preferably with beta-blockers and Ca-antagonists.