| Objective: Three-dimensional speckle tracking imaging(3D-STI)was used to evaluate the right heart function in hypertensive patients,and the parameters obtained by 3D-STI and two-dimensional echocardiography were compared for regression analysis and correlation analysis.Clinical value of scientific evaluation of right heart function in hypertensive patients.To compare the diagnostic efficacy of various myocardial strain parameters in the evaluation of right heart function in hypertensive patients by 3D-STI.Data and Methods: A total of 55 patients with essential hypertension WHO were examined in our hospital from 2021 to 2023 were selected.All the patients met the diagnostic criteria for essential hypertension formulated by WHO/ISH in 1999,and their sinus rhythm was between 25 and 70 years old.Based on the statistics of the basic information of the patients,eligible patients with essential hypertension were divided into a high LVMI group(25 cases in total)and a normal LVMI group(30 cases in total)according to the values of left ventricular mass index(LVMI).According to the demographic characteristics of patients with essential hypertension,30 normal control cases were selected.Left ventricular end-diastolic diameter(LVDD),left ventricular posterior wall thickness(LPWT),interventricular septal thickness(IVS),and tricuspid annular plane systolic excursion(TAPSE)were measured by two-dimensional echocardiography.Right ventricular ejection fraction(RVEF),right ventricular global longitudinal strain(RVGLS),right ventricular global circumferential strain(RVGCS),right ventricular global area strain(RVGAS)and other right ventricular function parameters were measured by 3D-STI.The measured parameters of each group were compared and analyzed to study the general law of related parameters change in patients with hypertension.To study the changes of myocardial strain parameters in the course of hypertension and determine the correlation between them and hypertension.Then,according to the sensitivity and specificity of RVGLS,RVGCS,RVGAS,TAPSE and decreased right ventricular systolic function(RVEF≤45%),the receiver operating characteristic curve(ROC)was described.Comparing the area under curve(AUC)with different parameters can effectively verify the diagnostic efficacy of various myocardial strain parameters and TAPSE on right heart function in patients with hypertension.Research Result: 1.RVEF showed a decreasing trend in the control group,normal LVMI group and high LVMI group,and the difference between groups was compared with P<0.05,which was statistically significant.RVGLS,RVGCS and RVGAS in the hypertension group were all decreased compared with the normal control group,and the decrease was more obvious in the high LVMI group,and the difference among the three groups was statistically significant(P<0.05).However,TAPSE only showed a statistically significant difference between the high LVMI group and the control group in the assessment of right ventricular function(P<0.05),indicating that 3D-STI could detect changes in right ventricular systolic function earlier than two-dimensional ultrasound.2.Pearson correlation analysis showed a strong correlation between RVEF and TAPSE(r=0.725,P<0.01).Similarly,RVGLS,RVGAS,and RVGCS measured by 3DSTI were negatively correlated with hypertension(r=-0.739,P<0.01;r=-0.755,P<0.01;r=-0.805,P<0.01).3.In order to standardize the standard of echocardiography measurement,the American Association of Echocardiography(ASE)has issued echocardiography guidelines,in which RVEF≤45% is considered as the standard of decreased right ventricular systolic function.Binary logistic regression analysis showed that TAPSE,RVGLS,RVGAS and RVGCS were correlated with decreased right ventricular systolic function(P<0.01).The ROC curve was used to evaluate the clinical value of the above four parameters in the diagnosis of decreased right ventricular function in hypertensive patients.The results showed that when RVGLS was lower than 14.45(AUC=0.833,P< 0.01),the sensitivity and specificity of the diagnosis of decreased right ventricular function in hypertensive patients were 71.9% and 82.1%.When RVGAS was lower than 12.64(AUC=0.746,P < 0.01),the diagnostic sensitivity and specificity of decreased right heart function in hypertension were 70.2% and 75%.When the RVGCS was lower than 23.08(AUC=0.751,P < 0.01),the diagnostic sensitivity and specificity were 82.5% and 71.4% in hypertensive patients with decreased right heart function.When TAPSE was lower than 18.5(AUC=0.779,p < 0.01),the diagnostic sensitivity and specificity were 78.9% and 75.0% in hypertensive patients with decreased right heart function.By comparing the area under the curve,it can be inferred that RVGLS has the highest application value in diagnosing decreased right heart function in hypertensive patients.Therefore,it can be inferred that 3D-STI has a higher diagnostic value in evaluating decreased right heart function in hypertensive patients than two-dimensional echocardiography.Conclusion: We studied right ventricular function in hypertensive patients with normal left ventricular function and found that changes in right ventricular systolic function can occur in the absence of normal left ventricular function.3D-STI can not only verify the changes in right heart function when left ventricular function is normal,but also in the early stage of hypertension,when left ventricular remodeling has not occurred,TAPSE is also reduced compared with the control group,but the difference is not statistically significant.In contrast,RVEF,GLS,GAS and GCS measured by 3D-STI not only decreased in the normal LVMI group compared with the control group,but the differences were statistically significant.3D-STI can also be used to evaluate the right heart function in hypertensive patients in terms of myocardial strain,and among the three strains of RVGLS,RVGAS,RVGCS and TAPSE assessment of the right heart function compared with two-dimensional echocardiography,RVGLS has the highest application value in the evaluation of right heart function.It can also predict the decrease of right heart function in hypertension.It is concluded that3D-STI can scientifically and effectively evaluate right heart function in hypertensive patients. |
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