Relationship Between Left Ventricular Filling Pressure And Left Ventricular Longitudinal Strain In Primary Hypertension Patients

Objective To compare the left ventricular myocardial strain by the speckle tracking technique in different left ventricular filling pressure groups in patients with normal left ventricular ejection fraction and discuss the risk factors of subclinical left ventricular systolic dysfunction decline.Methods We retrospectively included 210 cases of essential hypertension patients who took part in the Annual Check of Chronic Disease Management in Liao bu Town,Dongguan City,from September 2012 to December 2012.Inclusion criteria:diagnosed as essential hypertension;sinus heart rate.Exclusion criteria:secondary hypertension,acute myocardial infarction,acute and chronic heart failure,atrial fibrillation.Valve stenosis(mean mitral valve transvalvular pressure difference>5mmHg,aortic valve transvalvular mean pressure difference>10mmHg)or moderate and above valve regurgitation(reflux area>4cm2).Conventional two-dimensional echocardiography was performed with left ventricular ejection fraction(LVEF)<50%and segmental wall motion abnormalities.Left ventricular strain auto-tracking invalid segment ? 2.Echocardiography was performed in 2012 and 2014 respectively.Dynamic images were analyzed for left ventricular myocardial systolic global longitudinal strain(GLS),left ventricular longitudinal peak systolic strain rate(SRs),early diastolic peak strain rate(SRe),late diastolic peak strain rate(SRa).According to the 2012 baseline data,the E/e' ratio was divided into three groups,group A(E/e'<8),group B(8?E/e'?14),and group C(E/e'>14).Results Compared with group A,group C had a higher age,higher systolic blood pressure,lower diastolic blood pressure,and greater waist-hip ratio(P<0.05).There was no significant difference in GLS between group A and group B,but GLS in group C was significantly lower than that in group A(P<0.05).There was no significant difference in SRs between the three groups.The mitral annulus systolic myocardial velocity peak s' was significantly lower in group C than that in group A and B,left ventricular mass index and the ratio of left ventricular hypertrophy was significantly higher in group C than in group A and B(P<0.05).There was no significant difference in LVEF,FS,and SV between the three groups(P>0.05).The SRe and SRe/a in both groups B and C were significantly lower than those in group A.There was no significant difference in SRa.The IVS-e',LW-e',and IVS-a' of mitral annular diastole were also significantly lower than those of group A.In group C,the left atrial volume index(LAVI)was also significantly greater than that in group A.GLS and SRe were correlated with E/e'(P<0.05),Pearson correlation coefficient r was 0.153,-0.148,respectively.E/SRe is related to E/e',correlation coefficient r=0.426.Univariate logistic regression analysis showed that E/e' was not a predictor of GLS decline(GLS?-15.3%)(P=0.08),serum creatinine,BMI,LVEF,FS,IVS-s',IVS-e',LW-e',waist circumference was the influencing factor(P<0.05),multivariate analysis adjusted for age,systolic blood pressure,serum creatinine,BMI,LVEF,IVS-s',IVS-e',LW-e',waist circumference,only serum creatinine,LVEF,IVS-s',waist circumference were still independent factors of GLS decline.After 2 years of antihypertensive therapy,148 people were followed up.The GLS of group C was significantly lower than that of group A and B.The GLS of the three groups was improved compared with that of 2012,but patients of group B was significant improved(P<0.05).The changes of SRs,SRe,SRa were consistent with GLS,and that of B group was significantly improved(P<0.05).There was no significant difference in LVEF,FS and change values in each group in 2014.Conclusions In patients with essential hypertension with normal left ventricular ejection fraction,the left ventricular longitudinal strain in patients with elevated left ventricular filling pressure is significantly lower than those with normal left ventricular filling pressure;LVEF,IVS-s',serum creatinine,and waist circumference are the independent influence factors of left ventricular longitudinal strain decline;After 2 years of antihypertensive therapy,patients with left ventricular filling pressure between 8?E/e'?14 had significant improvement in left ventricular myocardial strain.