Evaluation Of Left Ventricular Torsion In Patients With Essential Hypertension By Three-dimensional Echocardiography Combined With Speckle Tracking Imaging

Objective The changes of left ventricular rotation and torsional motion and systolic synchro in patients with essential hypertension(EH)were evaluated by using two-dimensional speckle tracking imaging(2D-STI)and real-time three-dimensional echocardiography(RT-3DE),and the correlation between the two indexes and ejection fraction and between each other was discussed.The purpose is to help early clinical detection of changes in cardiac function in patients with hypertension,early drug intervention in patients with hypertensive heart disease,to help reduce the incidence and mortality of heart failure in patients with hypertensive heart disease.Methods A total of 87 patients with essential hypertension were enrolled in this study.According to the presence or absence of left ventricular remodeling,they were divided into normal left ventricular configuration(LVN)group(n = 29),concentric left ventricular hypertrophy(CCH)group(n = 28)and eccentric left ventricular hypertrophy(ECH)group(n = 30).Another 30 healthy patients who underwent physical examination in our hospital during the same period were selected as the control group,and the age and gender were matched between the two groups.The age,gender,body surface area(BSA),body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and other general clinical data of all subjects were recorded.Philips EPIQ7 C color Doppler ultrasound diagnostic instrument(equipped with Qlab15.0 analysis software)was used to obtaintwo-dimensional ultrasound images and parameters: Left ventricular end-diastolic diameter(LVEDd),end-diastolic interventricular septal thickness(IVSTd),end-diastolic left ventricular posterior wall thickness(LVPWTd),relative wall thickness(RWT);The parameters included peak basal rotation(Prot B),peak apical rotation(Prot A)and left ventricular torsion(LVtw).Three dimensional parameters included left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left ventricular myocardial mass index(LVMI),left ventricular systolic dyssynchrony index(SDI),time-volume curve,and bovine eye plot(IBE).The general clinical data,conventional two-dimensional ultrasound parameters,rotation and torsion parameters,and three-dimensional ultrasound parameters of all subjects were statistically analyzed and compared by SPSS27.0 statistical software,and the correlation between torsion parameters,ejection fraction and systolic dyssynchrony index in hypertensive patients was analyzed,Bland-Altman analysis was used to evaluate the intra-observer and inter-observer agreement.Results(1)There were no significant differences in age,gender,BMI and heart rate among the three groups(P > 0.05).Compared with the control group,the systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the LVN,CCH and ECH groups were significantly increased(P < 0.05),but there was no significant difference between the groups(P > 0.05).There was no significant difference in age,gender,BMI and HR among the groups(P > 0.05).(2)Compared with the control group,LVN group and CCH group,LVEDd was significantly increased in ECH group(P<0.05),and there was no significant difference among the other groups(P > 0.05).Compared with the control group,IVSTd and LVPWd were increased in the hypertension group(P<0.05),especially in the CCH group(P<0.05).RWT in the CCH group was significantly higher than that in the control group(P<0.05).(3)Compared with the control group,Prot B,Prot A and LVtw were increased in LVN group and CCH group(P<0.05),and the increase was more obvious in CCH group(P<0.05).Prot B,Prot A and LVtw were significantly decreased in ECH group.The differences were statistically significant(P<0.05).(4)Compared with the control group,LVN group and CCH group,EDV in ECH group was significantly increased,ESV and EF were significantly decreased(P<0.05),and there was no significant difference among the other groups(P > 0.05).SDI was significantly increased in the hypertension group,and showed an increasing trend.There were significant differences in SDI among the groups(P<0.05).Compared with the control group and LVN group,LVMI was increased in the CCH and ECH groups(P<0.05),and the increase was more obvious in the ECH group.There was no significant difference in LVMI between the normal control group and LVN group(P > 0.05).(5)pearson correlation analysis showed that Prot A and LVtw were positively correlated with EF(r=0.50,0.53 respectively,all P < 0.01),and Prot A and LVtw were negatively correlated with SDI(r=-0.61,-0.45 respectively,all P < 0.01).SDI was negatively correlated with EF(r=-0.47,P < 0.01).(6)Bland-Altman analysis of left ventricular torsion parameters、LVEF and SDI showed that the scatter points were within 95% limits of agreement,and the repeatability was good.Conclusions(1)With the development of hypertension,left ventricular rotation and twist increased compensatory in the early stage,decreased decompensation in the late stage,and left ventricular systolic dyssynchrony gradually became obvious.Both of them had a good correlation with ejection fraction,and the combination of them with ejection fraction could better observe the cardiac motion in patients with hypertension;(2)2D-STI and RT-3DE can better analyze the left ventricular twist and synchrony in patients with hypertension.The combination of 2D-STI and RT-3DE can help to detect the early changes of left ventricular twist and synchrony in patients with hypertension,and guide the clinical treatment and prognosis evaluation of patients with hypertension.