الفهرس 
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Abstract
Tissue Doppler imaging of the mitral annulus may predict the diastolic filling of left ventricle. Objectives: we investigated the pattern of diastolic function in a subset of hypertensive patients and evaluated the correlation between mitral annular TDI velocities & plasma level of NT pro BNP and its predictive cutoff value to diagnose LV diastolic dysfunction. Methods: After full clinical examination, we prospectively measured plasma level of NT pro BNP, assessed LVH by both ECG, Echo. we measured LV EF, Left atrial diameter , left venricular geometry and assessed LV diastolic function by both mitral flow pattern & mitral annular TDI parameters, in 40 Asymptomatic patients with normal EF (more than 55%) and 20 healthy control subjects. Results: We found that Ea velocities were decreased in hypertensive group with diastolic dysfunction. Moreover, E/Ea ratio was higher in hypertensive group(p=0.04) .the E/Ea was significantly& directly correlated with the level of NT pro BNP(r=0.41,P=0.008). The powerful predictors of NT pro BNP level in hypertensive patients with diastolic dysfunction were E/Ea(r=0.41,P=0.008), LVMI(r=0.41,P=0.015) and duration of hypertension(r=0.6,P=0.0001). Moreover, the powerful predictor of concentric LVH geometry is the duration of the hypertension(r=0.42, P=0.01). The cutoff point of NT pro BNP plasma level to detect diastolic dysfunction in asymptomatic hypertensive patient were 40.7 pg/ dl (sensitivity 95% and specificity 84%). Conclusion: Combination of tissue Doppler parameter and NT pro BNP plasma level offers a new strategy of risk stratification in hypertension. NT pro BNP is a promising marker to detect the subclinical state of heart failure with normal ejection fraction especially in hypertensive patient with diastolic dysfunction.