Association of a prothrombotic state with left-ventricular diastolic dysfunction in hypertension: a tissue-Doppler imaging study

Objectives: In hypertensive patients the propensity to develop organ damage is under the influence of several factors, including the existence of a prothrombotic state. We tested the hypothesis that an activated hemostatic system is associated with left-ventricular diastolic dysfunction as assessed by tissue-Doppler imaging (TDI). Methods: In 198 patients with untreated essential hypertension free of clinically relevant cardiovascular complications, we measured plasma levels of fibrinogen, prothrombin fragment 1 + 2, D-dimer, plasminogen activator inhibitor-1, and tissue plasminogen activator, and performed conventional echocardiography and TDI. Results: Left-ventricular diastolic dysfunction was detected in 61 patients (31%) by conventional echocardiography and in 105 patients (53%) by TDI, 39% of whom had left-ventricular hypertrophy. Left-ventricular hypertrophy was associated with increased plasma fibrinogen and prothrombin fragment 1 + 2 levels. Patients with diastolic dysfunction at TDI were older and had greater BMI, SBP, left-ventricular mass index, and plasma fibrinogen and D-dimer levels than patients with normal diastolic function. Variables of diastolic function measured both at conventional echocardiography and TDI were significantly related with age, BMI, left-ventricular mass index, and plasma fibrinogen, D-dimer, and prothrombin fragment 1 + 2. Multivariate regression analysis showed that diastolic variables obtained at TDI were related to plasma fibrinogen levels independent of covariates. Conclusion: Elevated plasma levels of fibrinogen and a prothrombotic state are associated with the presence of left-ventricular diastolic dysfunction in hypertensive patients with no evidence of ischemic heart disease and might increase the risk of diastolic heart failure.

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