Three-dimensional Speckle Tracking Imaging In Evaluation Of Left Ventricular Systolic Function With Different Patterns Of Hypertension

Objective：Using three-dimensional speckle tracking imaging (3D-STI) to compare thecharacteristics of left ventricular systolic function in normal persons and differentpatterns of hypertensive patients, and to determine the values of3D-STI in theevaluation of left ventricular systolic function in patients with hypertension.Methods：Totally90hypertension patients and30normal subjects (group N) were enrolled.According to Ganan classification, hypertension patients were classified into fourgroups:40cases in normal geometry group (group Ⅰ),20cases in concentricremodeling group (group Ⅱ),15cases in concentric hypertrophy group (group Ⅲ),and15cases in centrifugal hypertrophy group (group Ⅳ). Asked patients supine towardthe left side, calmly breathing, connected ECG. The main advantage of3D STE is thepossibility of analyzing the whole left ventricle from a single volume of data obtainedfrom the apical transducer position. Parameters of left ventricular (LV) systolic function,included LV ejection fraction (LVEF), global and segmental Longitudinal peak systolicstrain (LS), radical strain (RS), circumferential strain (CS), area strain (AS) and thecorresponding curves were analyzed.Results：1.General information: LVMI in groupⅠ～Ⅳ higher than that in group N(P<0.05),RWT,IVS,and LVPW in group Ⅱ, Ⅲ larger than the other groups (P <0.05), the valueof LVEF in group Ⅳ less than the other groups (P<0.05), systolic blood pressure,diastolic blood pressure and duration greater in groupⅠ～Ⅳ different from group N,which group Ⅲ, Ⅳ was higher than groupⅠ, Ⅱ (P <0.05); Body mass index in groupⅡ, Ⅲ, Ⅳ greater than group N, Ⅰ (P <0.05); Body surface area greater in group N, Ⅰ,Ⅱ less than group Ⅲ, Ⅳ (P <0.05)2. Normal control: The shape and form of strain curve of each segment werebasically the same in normal cardiac cycle. Curves of longitudinal strain, circumferential strain, and area strain are negative, whereas curves of radial strain arepositive. Both the time to peak was consistent, located at the end of ECG T-wave(end-systolic).At all myocardial level, LS and AS both had a basal-to-apex gradient. Thelongitudinal strain and area strain at the apical level were above the basal and middlelevels; radial strain was the smallest at the apical section.3.Hypertention cardiomyopathy: Global and segmental strain curves of LS、CS、AS maintained negative peak in each group with hypertension. RS was a positive peakcurve, but disordered relatively, the peak time was inconsistent, which has some delay.Global and segmental of LS、CS、AS in each group with hypertension significantly werelower than the control group (P <0.05); Global and segmental of LS、CS、AS in group Iwere lower than group N (P＞0.05); AS was significantly lower than the control group(P <0.05); Pearson rank correlation statistics showed that：GLS, GCS, GAS of leftventricular were negatively correlated with LVEF (r=-0.42,-0.50,-0.58, P <0.05),GRS was positively correlated with LVEF (r=0.41, P <0.05).Conclusions：1. Normal controls: At all myocardial level, LS and AS both had a basal-to-apexgradient. The longitudinal strain and area strain at the apical level were above the basaland middle levels; radial strain was the smallest at the apical section.2. Hypertension cardiomyopathy:3D strains were decreased with the severity ofleft ventricular remodeling, We could detect early abnormalities of left ventricularsystolic function by area strain, so as to provide reference for clinical about earlyprevention and treatment of hypertensive heart disease.3.3D-STI is a sensitive, objective method to detect early and subtle LV systolicdysfunction, providing a new method for the analysis of left ventricular systolicfunction with different patterns of hypertension.