| Backgrounds and ObjectivesAn accurate assessment of left ventricular systolic and diastolic characteristics changes at different stages of hypertension is important in the early detection of heart disfunction, heart failure occurrence and development hemodynamic mechanism as well as the prognosis. This study aimed to investigate myocardial multi-dimensional systolic deformation in primary hypertension(HT) patients of various left ventricular (LV)geometry using 2-dimensional strain echocardiography (2DSE) and to explore the relationships between myocardial systolic multi-dimensional deformation and LV geometry and global LV function.Methods221 patients with HT (male 148, female 73, average age 57.41±11.35 years) except valvular heart disease, diabetes mellitus and cardiomyopathy as HT group. 30 age- and gender- matched normotensive healthy volunteers (male 16, female 14, average age 56.73±8.86 years) as the control group. HT patients were divided into four groups according to Ganau categories with left ventricular mass index(LVMI) and relative wall thickness(RWT): normal geometry(group NG, 122 cases) , concentric remodeling(group CR, 52 cases) , concentric hypertrophy(group CH, 23 cases) and eccentric hypertrophy(group EH, 24 cases).Echocardiographic examination was performed to acquire parameters including LV diameter, wall thickness, left atrial size, LV ejection fraction (LVEF) , short-axis fractional shortening(FS), transmitral diastolic inflow velocities(E, A) , mitral annuluar systolic, early, late diastolic velocities(Sa, Ea, Aa) , and 2DSE measurements include endsystolic LV longitudinal strain (SL) , radial strain (SR),circumferential strain (SC) ,rotation angle (Rot) and twist angle (Twist).According to the consensus on diagnosis of diastolic heart failure by the European Society of Cardiology(ESC) in 2007, E/Ea is recommended to distinguish whether LV filling pressure is elevated or not. HT patients with E/Ea less than 8 were defined as normal filling pressure(group A, 48 cases) and E/Ea over 15 as elevated filling pressure(group B, 37 cases), and patients with 8≤E/Ea≤15 would not discussed here.Results1. In the whole HT group (221 cases),LV mass, left atrial volume and E/Ea were increased, and both Ea and SL were decreased [SL(20.56±4.00)% vs(23.96±2.72)%,p<0.01] . But there was no significant difference in LVEF, SR, SC and Twist [LVEF(62.15±8.21)% vs(63.99±4.79)%,p >0.05].2. In group NG and group CR, SL was lower than that in the control group[(22.16±2.74)%,(20.14±3.49)% vs (23.96±2.72)%,p<0.05], SC and SR were no decreased , while Twist was slightly increased [(25.29±9.23)%,(26.57±8.53)% vs (23.41±6.79)%, p>0.05]; but in group CH and group EH, SL, SC and SR were all lower than those in group NG and group CR(p <0.05), while Twist was no significant difference with the control group.3. Compared with group A, significant decreases of SL, SC, SR and LVEF were found in group B [SL (21.25±2.39)% vs (17.66±5.97)%, p<0.05; LVEF (62.17±5.89) % vs (57.03±12.64)%, p<0.05], and no significant difference in Twist [(23.91±9.93) % vs (25.10±9.28)%, p >0.05].Conclusions1. Alough LV pump function of HT patients was preserved, myocardial systolic deformation was impaired. In early stage of LV remodeling ( group NG and CR) SL was decreased, and in hypertrophic patterns(group CH and EH) SL, SC and SR were significantly decreased. And preserved LV twist might contribute to preserve LVEF in HT patients of various LV geometry.2. Diastolic dysfunction of HT patients was aggravated with reconstruction as well as the decrease of myocardial systolic deformation. Myocardial multi-dimensional deformation in HT patients with elevated LV filling pressure was significantly lower than that in normal LV filling pressure, and Twist was still preserved, which might help to understand the hemodynamic mechanism of heart failure with normal LVEF . |
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