Noninvasive assessment of left-ventricular diastolic electromechanical coupling in hypertensive heart disease

  • Yuko Saito
  • Hirotsugu YamadaEmail author
  • Kenya Kusunose
  • Ken Saito
  • Masataka Sata
Original Investigation



There is a need to stratify patients who may develop heart failure because of the current “heart failure pandemic”. We hypothesized that noninvasive assessment of diastolic electromechanical coupling by electrocardiography and Doppler echocardiography may be clinically useful for risk stratification of hypertensive patients who may develop heart failure.


We measured the time from the peak to end of the T wave (TpTe) as an electrophysiological parameter, and peak early diastolic mitral flow (E) and lateral annular (e′) velocities as mechanical parameters in 109 patients with hypertension. Relationships between these parameters and their association with the prognosis were evaluated.


The e′ was inversely correlated with TpTe (p < 0.001) and QTc (p < 0.014), whereas E/e′ was positively correlated with TpTe (p < 0.001) and QTc (p < 0.001). The TpTe predicted patients with E/e′ > 12. There were 24 cardiovascular events during follow-up (57 ± 20 months), and Kaplan–Meier analysis showed that outcome was worse (p = 0.003) in patients with higher E/e′ than lower E/e′; however, there was no difference between patients with longer TpTe (≧72 ms) and shorter TpTe (< 72 ms).


The correlation of TpTe with e′ and E/e′ in hypertensive patients suggests that these parameters reflect diastolic ventricular electromechanical coupling. The E/e′ predicted outcome, and an elevated E/e′ should be suspected when TpTe is prolonged (> 72 ms). Noninvasive evaluation of diastolic electromechanical coupling is clinically useful in patients with hypertension for predicting their outcome.


Tpeak–Tend interval E/e′ Hypertension Diastolic electromechanical coupling 



This work was partially supported by JSPS KAKENHI Grants (Nos. 16H05299 and 26248050 to MS) and the Grants-in-Aid from the Takeda Science Foundation (to MS), the Fugaku Trust for Medical Research (to MS), and the Vehicle Racing Commemorative Foundation (to MS).

Compliance with ethical standards

Conflict of interest

Yuko Saito, Hirotsugu Yamada, Kenya Kusunose, Ken Saito, and Masataka Sata declare that they have no conflict of interest.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

12574_2019_421_MOESM1_ESM.tif (1.2 mb)
Supplement figure 1. Measurement of TpTe. Time from the peak of the T-wave to the end of the T-wave (TpTe) in the 12-lead ECG was measured in lead V5. If this could not be measured in lead V5, and then, we used other leads. (TIFF 1196 kb)


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Copyright information

© Japanese Society of Echocardiography 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineTokushima University HospitalTokushimaJapan
  2. 2.Department of Community Medicine for CardiologyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
  3. 3.Department of ChronomedicineTokushima UniversityTokushimaJapan

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