Doppler Evaluation of eft Ventricular Diastolic Fillin in Children with Systemic Hypertensio A. REBECCA SNIDER, MD, SAMUEL S. GIDDING, MD, ALBERT . ROCCHINI, MD, AMNON ROSENTHAL, MD, MACDONALD DICK II, MD, DENNIS C. CROWLEY, and JANE PETERS To assess left ventricular (LV) diastolic function in children with systemic hypertension, 11 patients with hypertension (mean blood pressure 99 mm Hg) and 7 normal patients (mean blood pressure 78 mm Hg) underwent M-mode echocardiography and pulsed Doppler examination of the LV inflow. From a digitized trace of the LV endocardium and a si- multaneous phonocardiogram, echocardiographic diastolic time intervals, peak rate of increase in LV dimension (dD/dt), and dD/dt normalized for LV end-diastolic dimension (dD/dt/D) were measured. Doppler diastolic time intervals, peak velocities at rapid filling (E velocity) and atrial contraction (A velocity), and the ratio of E and A velocities were measured. The following areas under the Doppler curve and their percent of the total area were de- termined: first 33% of diastole (0.33 area), first 50% of diastole, triangle under the A velocity (A area), and the triangle under the E velocity (E area). The A velocity (patients with hypertension = 0.68 f 0.11 m/s, normal subjects = 0.49 f 0.08 m/s), the 0.33 area/total area (patients with hypertension = 0.49 f 0.09, normal subjects = 0.58 f 0.08), the A area (patients with hypertension = 0.17 f 0.05, normal subjects = 0.12 f 0.03), and the A area/total area (patients with hypertension = 0.30 f 0.11, nor- mal subjects = 0.20 f 0.07) were significantly differ- ent between groups (p <0.05). M-mode and Doppler time intervals, (dD/dt)/D, E velocity, and the remain- ing Doppler areas were not significantly different be- tween groups. The normal subjects and patients with hypertension did not differ significantly in echocardio- graphic LV size and thickness or in percent shortening fraction. This study shows that abnormal patterns of LV diastolic filling occur in children with mild systemic hypertension. These diastolic abnormalities are de- tectable by mitral valve Doppler ultrasound examina- tion when standard M-mode echocardiographic in- dexes of diastolic function are still normal and before the development of systolic function abnormalities or LV hypertrophy on the M-mode echocardiogram. (Am J Cardiol 1985;56:921-926) Several recent echocardiographic and radionuclide studies have demonstrated left ventricular (LV) dia- stolic filling abnormalities in patients with a variety of cardiac diseases, including coronary artery disease, hypertrophic cardiomyopathy and systemic hyperten- sion.l-1s With the use of noninvasive indexes of LV relaxation and filling, these studies have shown that diastolic dysfunction often precedes systolic dysfunc- tion and is often detectable in asymptomatic pa- tients.2!4J4 Some investigators have suggested that dia- stolic abnormalities are a characteristic finding in adult patients with early hypertensive heart disease.4>6J0J2 In this study we assessed LV diastolic function in a group of children with mild systemic hypertension using the noninvasive techniques of M-mode and Doppler echocardiography, identified the most sensitive Doppler From the Department of Pediatrics, C. S. Mott Children’s Hospital, University of Michigan Medical Center. Manuscript received March 15, 1985; revised manuscript received May 22, 1985, accepted May 28, 1985. Address for reprints: A. Rebecca Snider, MD, Associate Professor of Pediatrics (Cardiology), F1809, 6. S. Mott Children’s Hospital, Ann Arbor, Michigan 48109-0010. 921 indexes of LV relaxation, and compared the M-mode and Doppler techniques in their ability to detect early abnormalities of diastolic compliance. Methods Patients: The patient group included II children with systemic hypertension and 7 normal children. The normal group consisted of 3 girls and 4 boys who had no evidence of heart disease on physical examination or on M-mode and 2- dimensional echocardiography. They were 10 to 18 years old (mean 15) and weighed 41 to 73 kg (mean 64). The systolic blood pressure of the normal group at the time of the echo- cardiographic studies was 111 f 8 mm Hg (mean f standard deviation); the diastolic blood pressure was 62 f 8 mm Hg. The systemic hypertension group consisted of 6 girls and 5 boys who were randomly selected from the outpatient hy- pertension clinic. They were 1.4 to 17 years (mean 11) and weighed 8.9 to 75 kg (mean 42). The systolic blood pressure of the hypertension group at the time of the echocardiographic studies was 131 f 13 mm Hg; the diastolic blood pressure was 82 f 14 mm Hg. In the hypertension group, 7 children had essential hypertension, and 1 each had William’s syndrome, primary aldosteronism, previous repair of coarctation of the aorta and atrophic pyelonephritis. The time interval from the