Study Of Left Ventricular Myocardial Strain And Cardiac Function In Patients With Essential Hypertension By Two-dimensional Speckle Tracking Imaging

Objective To assess left ventricular function with the peak systolic strain oflongitudinal、radial and circumferential in patients with essential hypertension by usingtwo-dimensional speckle tracking imaging.Method63patients with essential hypertension (EH)(male32, female31, average age50.64±8.92) were enrolled, who were divided into the left ventricular hypertrophy group(n=30) and non left ventricular hypertrophy group(n=33), according to left ventricular massindex (LVMI); all above cases fulfilled diagnostic criteria in《2010Chinese HypertensionPrevention Guide》, and the left ventricular ejection fraction(LVEF) was preserved (≥50%)in the2EH groups；in addition to, all EH cases were excluded other heart diseases, includingof secondary hypertension、coronary heart disease、severe valvular disease、severe liver andkidney dysfunction, and the image of case is not clear.49gender-、age-and body surfacearea-mathed normotensive healthy volunteers were regarded as the control group(male21, fe-male28, average age48.06±8.11).Philips IE33color Doppler ultrasonic diagnostic equipment was used in this research; thesubjects were asked to left lateral decubitus position, ECG was performed simultaneously, toget all study patients routine ultrasound indicators: left atrial diameter(LAD), left ventricularend-diastolic diameter (LVDd), left ventricular end-systolic diameter(LVDs), interventricularseptal end-diastolic thickness(IVSTd), left ventricular posterior wall end-diastolicthickness(LVPWTd), fractional shortening (FS); transmitral diastolic early peak inflowvelocity (E), transmitral diastolic late peak inflow velocity (A) and E/A ratio, early diastolic velocities of mitral annulus(Ea)﹑atrial peak systolic velocity (Aa) and Ea/Aa ratio in TissueDoppler mode; Measure left ventricular ejection fraction(LVEF)by Simpson method, andmeasure Left ventricular mass(LVM) and Left ventricular mass index(LVMI). In thetwo-dimensional speckle tracking imaging mode, the image were collected by left ventricularapical four-chamber view、apical two-chamber view、left ventricular long-axis three-chamberview、short axis view of the mitral valve level、papillary muscle level、apex level; and all ofimages were contained at least three cardiac cycles; The peak systolic longitudinal strain(LS)、the peak systolic radial strain(RS) and circumferential strain (CS) were measured ofeach segment in left ventricular long-axis and short-axis views by Qlab software.Results1. General echocardiographic parameters in three groups: in the NLVH groups, the LAD、IVST、LVPWTd、LVM and LVMI were significant higher than the normal groups(P <0.01);the LAD、LVDd、LVDs、IVST、LVPWTd、LVM and LVMI of the LVH groups increasedmarkedly composed with the control and NLVH groups(P <0.05).2. The conventional systolic and diastolic function parameters comparison in the three groups:the E、E/A ratio、Ea and Ea/Aa ratio in hypertensive each group were significantly lower thanthe normal group(P <0.01),with the NLVH group, the Ea/Aa ratio in the LVH group coulddecreased(P <0.05); the LVEF and FS have no difference among the three groups(P0.05).3. The peak systolic LS peak values in three groups: the peak of longitudinal strain curve ineach segment of left ventricular were all negative in control groups, which is in systolic; thehypertension in each groups have similar performance; the mean peak systolic longitudinalstrain of each segment and global in LVH groups were lower significantly than that in thecontrol and NLVH groups(P <0.01).4. The peak systolic RS peak values in three groups: the peak of radial strain curve in eachsegment of left ventricular were all positive in control groups, which is in systolic; the NLVHand LVH groups have showed similar performance; the mean peak systolic radial strain of three segments and global in NLVH groups increased compared to the control group(P <0.01), but the above mention of LVH groups decreased significantly compared with thecontrol and NLVH groups(P <0.01).5. The peak systolic CS peak values in three groups: the peak of circumferential strain curvein three segments of left ventricular were all negative in three groups, which is in systolic, theboth hypertension groups show negative peak curve at the same time; the mean peak systoliccircumferential strain of three segments and global in LVH groups were slight lower than thatin the control and NLVH groups (P <0.05).Conclusions1. The left ventricular diastolic function has been damaged at early hypertensive patients thatthe left ventricular systolic function preserved; compared with mitral orifice flow Dopplerfrequency, Tissue Doppler imaging can more accurate and evaluate left ventricular diastolicfunction.2. When left ventricular pump function of essential hypertensions were preserved, the systolicfunction of left ventricular local myocardial have decreased; therefore,2D-STI can early andaccurately access left ventricular systolic function in global or local region of essentialhypertension, which has provided a new method for clinical diagnosis and treatment.3. The longitudinal strain of left ventricular has decreased in non left ventricular hypertrophyof hypertension, and may occur circumferential strain elevated, but not significantly, theradical strain compensatory increase, but further development of hypertension, the leftventricular occur remodeling, the three kinds of strain all decreased.