الفهرس 
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Abstract
Diastolic dysfunction is common clinical entity among heart failure patients, diastolic dysfunction refers to abnormalities in left ventricular distensibility, filling or relaxation. The spectrum of diastolic disease extends from the asymptomatic phase to fulminant cardiac failure (HFPEF). These patients are commonly encountered in critical care units Epidemiological and clinical studies suggest that HF with a preserved ejection fraction will become the more common form of HF which clinicians will encounter.
Diastolic dysfunction in the absence of symptoms is common in elderly hypertensive patients. Heart failure with a preserved ejection fraction (HFpEF), or diastolic HF, refers to the clinical syndrome of HF coupled with evidence of diastolic dysfunction and is estimated to occur in approximately 50% of patients with chronic HF.
The most common causes for diastolic dysfunction are Hypertension, cardiac ischemia, ageing, obesity and aortic stenosis.
LVH is a complex cardiac phenotype resulting from the response of myocyte and nonmyocyte components to mechanical and hormonal stimuli and it increases the risk of myocardial infarction, stroke, and death.
LVH can be detected by electrocardiography via several electrocardiographic criteria of the most important of them is the Cornell product, LVH can also be diagnosed by others diagnostic tools for examples Echocardiogram and cardiac MRI.
Cornell product can be calculated simply from ECG via the following formula:
Cornell product = SV3 + RaVL (+8 in women a) x QRS duration ≥ 2,440 mm × ms
The aim of the study was to test the benefit of using of the electrocardiographic Cornell product as an indicator of LV diastolic dysfunction which confirmed later by echocardiogram.
The study was conducted at Alexandria Main University Hospital and medical research institute. One hindered patients presented to hypertension clinic and cardiology clinic or admitted in Alexandria Main University Hospital and medical research institute for different other causes for example ischemic heart disease, valvular heart disease all of them had a positive Cornell product. The one hindered patients underwent a full echocardiographic study.
The patients were interviewed for their previous medical history. Complete clinical examination was done. The main method of the study was assessment of the diastolic function using mitral inflow velocities (mitral E velocity, A velocity and E/A ratio), tissue Doppler imaging( septal and lateral annular velocity, E/E’ ratio), deceleration time, isovolumic relaxation time, left atrial Enlargement, left ventricular mass index for all the one hudered patients with Cornell product ECG-LVH criteria, according to the result of the previous echocardiographic parameters grading of diastolic dysfunction was done according to 2009 EAE/ASE recommendations for the evaluation of left ventricular diastolic Function.
The study included (59) male and (41) female with a mean age of 57.05 ± 12.74 years. The patients were classified into two groups: group A consisted of patients with normal diastolic function, and group B consisted of patients with abnormal diastolic function those patients were subdivided into three subgroups according to the grade of diastolic dysfunction.
A normal diastolic function was found in 14 % of patients. The remaining 86 % exhibited abnormal diastolic function with various degrees. Of 86 patients with diastolic dysfunction patients 65 patients were hypertensive, mean QRS duration = 98.14 ± 11.73msec;with a mean of QRS duration of 96.25 ± 12.65 msec in subgroup I, and 100.56 ± 10.40msec in subgroup II, and 100.0 ± 0.0 msec in subgroup III. the mean CP was 2948.6 ± 496.7mv x ms ; in subgroup I it was 3080.0 ± 485.72 mv x ms, and in subgroup II it was 3550.0 ± 636.40 mv x ms, and in subgroup III it was 2901.0 ± 480.90 mv x ms.
The statistically significant ECG predictors for diastolic dysfunction among the ECG parameters were the QRS duration and the Cornell product while the heart rate and the Cornell voltage criteria were not significant predictor of diastolic dysfunction. while among the echocardiographic parameters the statistically significant parameter to diastolic dysfunction were E/A ratio, deceleration time and LAVI. The other Echocardiographic parameters were not statistically significant correlated to diastolic dysfunction.
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