Assessment Of Left Ventricular Long-axis Function In Patients With Essential Hypertension Using Real-time Three-plane Quantitative Tissue Velocity Imaging And Speckle Tracking Imaging

ObjectiveHypertension is a frequently encountered disease which can cause the hazard to people health.The most is myocardial remodeling.The pathophysiologic progress contributes the change of cardiac function.As a high risk factor of coronary artery diseases,the cardiovascular morbidity will increase obviously.It is very important for prevention and treatment to evaluate the cardiac function of hypertensive patients in the early phase.The quantification of velocity and strain measurements derived from TDI has been extensively validated.Among them, based on the TDI technology Quantitative tissue velocity imaging(QTVI) may in a two-dimensional supersonic section, simultaneously carry on the sample to the many stage partial cardiac muscle, demonstrates many sample spot cardiac muscle in a cardiac cycle decided but not yet announced quantity the velocity of movement change curve, but real-time carries on the accurate quantitative evaluation to hypertension sickness patient left ventricular partial myocardial tissue velocity.The angle dependency of Doppler based techniques restrict its clinic application.Speckle tracking imaging(STI)is a novel approach for assessment of LV global and regional function from two一dimensional echocardiographic images in recent years,which is angel independency.The principle of STI is based on tracking of natural acoustic markers from frame to frame created by interference of ultrasound beams in the myocardium,and then obtain the myocardial strain by tracking the acoustic markers displacements.The aim of this study was to validate Triplane-QTVI and STI as methods for evaluating the left ventricular systolic function of essential hypertensive patients by analyzing the left ventricular diastolic and systolic index in hypertensive patients.Materials and MethodsThe group normal controls consisted of 40 subjects, Group patients consisted of 60 patients with hypertension.Patients with hypertension were divided into two subgroups on the basis of the left ventricular mass index(LVMI),included the normal group without ventricular hypertrophy(nLVH , 30 )whose LVMI were within the normal range.And the other group is the left ventricular hypertrophy(LVH , 30 )group,whose LVMI were above the range.All subjects were examined in the left lateral decubitus position, using a commercially available echocardiogmphic system with color doppler imaging capabilities(Vivid 7,GE Corp.,USA)equipped with M3S phased-array transducer(1.5~4.3MHz) and 3V three dimensional heart probe . The ECG was recorded simultaneously . Digital echocardiographic data were acquired during passively held end-expiration and transferred on to EchoPAC Multi-parameter analysis workstation for off-line analysis.M-mode tracings from the parasternal Long-axis view were used to measure diameter of the left atrium(LAD),1eft ventricular end-diastolic diameter(LVEDD) and interventricular septal end-diastolic dimension(IVSTd), and left ventricular posterior wall end-diastolic thickness(LVPWTd).Then LVEF was calculated.Pulsed-wave Doppler of transmitral were obtained form the apical four chamber view.The following parameters were measured:peak velocity of early rapid filling(E),peak Velocity of atrial filling(A) and the ratio of E to A(E/A).Then the Triplane tissue velocity images of apical four-chamber view were obtained. The 6 walls of left ventricle were divided into basal and middle segments and apical segments. Peak systolic velocity (Vs) early diastolic velocity (Ve) and late diastolic velocity (Va) at six sites of mitral annulus were measured using QTVI.Speckle tracking imaging(STI):Under standard two dimensional echocardiography mode,using STI analysis software,we could measure SLs,SrLs,SrLe and SrLa in three apical Views of left ventricular long axis.An measurements were taken as the mean of three consecutive beats.Results1 Comparisons of clinical data among three groups:Compared with the control group thickness of interventricular septal wall and LAD significantly different in the LVH group(P<0.05),while peak E mitral inflow velocity decreased,and E/A ratio decreased significantly(.But E/A ratio was not significantly different between nLVH group and LVH group(P>0.05) . LVEF was also not significantly different among the three groups(P >0.05).2 Applicate the RT-3PE QTVI to measure the longitudinal changes in left ventricularCompared with the control group , the parameters of Ve,Ve/Va was significantly reduced. There was a significantly different in nLVH group and LVH group(P<0.05); And LVH group were significantly lower than nLVH group in the parameters of Ve; Ve/Va: LVH group and nLVH group were significantly lower than the control group(P<0.05).3 Strain tissue imaging(STI) was used to measured regional systolic peak longitudinalstrain(SLs) , systolic peal(Longitudinal strain rate (SrLs) , early diastolic peak longitudinal Strain rate(SrLe)and late diastolic peak longitudinal strain rate(SrLa) in three apical Views,and calculated the average values of each view and the global left ventricle. SLs and SrLe derived from S,Sr and STI were significantly lower in the two patient groups than that of control group and significant differences were observed between any two groups,while SrLa had no significant differences between any two groups.Conclusions1 Three-plane Quantitative Tissue Velocity Imaging can assess left ventricular long-axis systolic function correctly in patients with with Essential Hypertension.2 Speckle Tracking Imaging can assess left ventricular long-axis systolic function correctly in patients with with Essential Hypertension.3 STI is superior to TDI for angle independency,high repeatability and simple process of analysis.