The Influence Of Left Ventricular Configuration On The Evaluation Of Left Ventricular Diastolic Function In Chinese Adult With Hypertension

BackgroundHypertension(HTN)is a major risk factor for the morbidity and mortality of cardiovascular disease(CVD).Controlling hypertension can prevent the morbidity and mortality of cardiovascular and cerebrovascular diseases,but the prevalence of hypertension in China is still increasing.The awareness rate,treatment rate and control rate of hypertension is lower.Left ventricle is one of the main target organs of hypertension,and systemic hypertension causes excessive hemodynamic overload,which can lead to left ventricular hypertrophy(LVH)and structural changes.Some studies have shown that the type of left ventricular remodeling is related to cardiovascular events and all-cause mortality.The geometric configuration differs in prognosis,and the prognosis is related to left ventricular mass.Concentric hypertrophy(CH)is the highest Left ventricular mass(LVM)in the left ventricle remodeling and the worst prognosis.followed by eccentric hypertrophy(EH),concentric remodeling(CR).and normal left ventricular geometry(NG).During the development of ventricular remodeling and hypertrophy in patients with essential hypertension,myocardial contraction and diastolic function may decrease,eventually leading to heart failure.Some studies have shown that antihypertensive therapy reduce LVM and prevent or reverse the geometry of left ventricular abnormalities.Therefore,how to define the geometric of left ventricular remodeling and early assessment of the degree of left ventricular remodeling in essential hypertension has important guiding significance for the development of treatment options.Early intervention and treatment can help reduce the occurrence of CVD.At present,the research on hypertension configuration at home and abroad mostly adopts the Ganau classification.The evaluation criteria of LVH in the hypertension guideline are also based on the classification standard.However,the specific standard reference value of this classification is from the American and European populations.It is unclear whether the classification of the left ventricular geometric is consistent with the Western population and the effect on the reconstruction type ratio.To compare with Westerners,recent studies have found that Chinese have different normal reference values for conventional echocardiographic indicators.According EMINCA study,the normal value data of conventional ultrasound parameters of Chinese adults,it is speculated that there may be differences in relative wall thickness(RWT)and left ventricular mass index(LVMI).According to the characteristics of Chinese population configuration,research on hypertension classification is rare.Objectives1.According to the data of Chinese adult ultrasound indicators in EMINCA study,RWT and LVMI were calculated,and establish a reference standard for Chinese patients with hypertension left ventricular configuration.2.According to the Chinese left ventricular configuration reference method and the ASE/EACVI2015 and ESC/ESH2018 reference standard,the Ganau classification was carried out,and the distribution characteristics of the configuration were compared.3.The relationship between left ventricular diastolic function and left atrial size was compared between the Chinese reference method and the ASE/EACV12015 and ESC/ESH2018 reference standard for left ventricular remodeling in hypertension.Methods1.Study populationA total of 313 patients were enrolled in the study,and 236 patients were enrolled in the assessment of left ventricular diastolic function.77 healthy volunteers were selected from the control group.2.ExaminationEchocardiography was performed in all patients with hypertension and normal controls using Philips Epiq7C and ALOKA F75 color Doppler diasonograph simultaneous recording ECG.We acquired images of parasternal long axis view of left ventricular,A2C,A4C and dynamic images by two-dimensional echocardiography and issue Doppler images and t the corresponding Color Doppler flow images.3.EchocardiographyLeft ventricular end diastolic diameter(LVDd),left ventricular posterior wall thickness(PWTd),ventricular septal thickness(IVSd)and left ventricular end systolic left atrial diameter(LAD)were measured and then LVM,LVMI,RWTwere calculated.Left ventricular systolic left atrial volume(LAV)was measured by Simpson's biplane method and left atrial volume index(LAVI)was then calculated.Left ventricular ejection fraction(LVEF)was calculated.Early mitral valve diastolic E wave blood flow velocity(E),Mitral valve diastolic late A wave blood flow velocity(A),tricuspid regurgitation pressure gradient(TRPG),septal e,lateral e'was measured and peak velocity of tricuspid regurgitation(TRVmax),average E/e'ratio was calculated.4.Statistical analysisSPSS20.0 statistical software was used to analyze the data.T-test was used for comparison of two independent groups and the One-way ANOVA was used for comparison of four groups when the data were in normal distribution.Chi-square test was used for composition ratio data.The level of statistical significance was set at P<0.05.Results1.Clinical dataAge,weight,BMI,BSA,SBP,and DBP were higher in the hypertension group than in the normal control group(P<0.05).2.Echocardiogram basic indicatorsCompared with the normal control group,the IVSd,PWTd,RWT,LVM,LVMI,and LVM/height2.7 were significantly higher in the hypertension group(P<0.05).3.Chinese reference standard for left ventricular configuration of hypertensionAccording to the guidelines to redefine RWT and LVMI:RWT>0.51(male)or RWT>0.49(female);LVMI=LVM/BSA>108g/m2(male)or>99g/m2(female)when LVMI is applied to BSA for calibration;LVM/heihgt2.7>46g/m for both genders When LVMI is applied to heihgt2.7 for calibration.4.Distribution characteristics of left ventricular configuration in hypertension4.1 BSAAnalysis of according to ASE/EACVI2015 international reference standard,78 cases(24.9%)in the NG group,149 cases(47.6%)in the CR group,26 cases(8.3%)in the EH group,and 60 cases(19.2%)in the CH group.According to the newly established Chinese reference method-BSA,174(55.6%)in the NG group,41(13.1%)in the CR group,77(24.6%)in the EH group,and 21(6.7%)in the CH group,the results of the configuration of the above two reference standards were statistically significant(P<0.01).The incidence of left ventricular abnormalities in hypertension was 75.1%vs 44.4%(P<0.01),and the incidence of LVH was 27.5%vs 31.3%(P = 0.292).4.2 Height2.7According to the ESC/ESH2018 international reference standard,was adjusted by height2.7,88(28.1%)in the NG group,136(43.5%)in the CR group,33(10.5%)in the EH group,and 56(17.9%)in the CH group.According to the newly established Chinese reference method,was adjusted by height2.7,152(48.6%)in the NG group,39(12.5%)in the CR group,99(31.6%)in the EH group,and 23(7.3%)in the CH group.The results of the configuration of the above two reference standards were statistically significant(P<0.01).The incidence of left ventricular abnormalities was 71.9%vs 51.4%(P<0.01),and the incidence of LVH was 28.4%vs 39.0%(P=0.005).4.3BS A or Height2.4The results of the configuration and the incidence of left ventricular abnormal configuration were no different between the newly established two Chinese reference methods(P>0.05),and LVH rates were 31.3%vs 38.9%(P-0.045);there was no difference between the two international reference standards(P>0.05).5.Evaluation of left ventricular diastolic functionThere were 11 patients with diastolic dysfunction,35 patients with diastolic function,and 190 with normal diastolic function.Regardless of BSA or height 2.7 correction for LVM,According to Chinese reference method,left ventricular diastolic function was not determinedand and diastolic dysfunction was mostly distributed in NG and EH groups.According to the international reference standard,diastolic function could not be determined was mostly distributed in NG,CR and CH groups.Diastolic dysfunction is mostly distributed in the NG and CH groups.According to different reference standards,the LAD,LAV,LAVI,LAVI/height2,and E/e' hypertension groups in different subgroups of the same standard were higher than the control group(P<0.05),e'(s),e'(l)The hypertension group was lower than the control group(P<0.05).There was no significant difference in the diastolic function between the different subgroups(P>0.05).6.Left atrial sizeAccording to ASE/EACVI2015 guide,LAVI>34(mL/m2)for both genders,the incidence of left atrial dilatation was 20.3%:according to the EMINCA study,the left atrium dilatation LAVI>34.3(mL/m2)(male),LAVI>35.5(mL/m2)(female),the incidence of left atrial dilatation was 14.8%.The distribution of left atrial dilatation in the above two studies was no statistically significant(?2=2.471,P=0.116).According to the 2018 ESC/ESH guidelines for hypertension management,a new definition of left atrial dilatation is proposed,with LAV/height2>18.5(mL/m2)(male)and LAV/height2>16.5(mL/m2)(female).the incidence of left atrial dilatation was 54.7%.Using the data of normal Chinese adults of EMINCA study,the same calculation method was used to obtain the abnormal threshold distribution characteristics of left atrial dilatation in Chinese adults.LAV/height2>21(mL/m2)(male),LAV/height2>22(mL/m2)(female),the incidence of left atrial dilatation was 23.3%.The distribution of left atrial dilatation obtained by the above two reference criteria was statistically significant(?2=48.775,P<0.01).The distribution of left atrial dilatation obtained by two international reference standards,ASE/EACVI2015 and ESC/ESH2018,was statistically significant(?2=59.308,P<0.01).Conclusions1.The EMINCA study data was used to establish a reference method for left ventricular configuration in Chinese adults.Compared with the ASE/EACVI2015 recommended reference standard,the upper limit of normal RWT is higher,the male is larger than the female.The LVMI is smaller in men and larger in women.Compared with the ESC/ESH2018 recommended reference standard,the upper limit of normal RWT is larger,and the LVMI is smaller.2.There is a significant difference in the distribution of left ventricular configurations between the Chinese reference method and the international reference standard.Moreover,the abnormal distribution of left ventricular diastolic function is different from the type of left ventricular remodeling.3.When using BSA indexed,the left atrial dilatation standard recommended by the ASE/EACVI2015 guidelines is also applicable to the Chinese population;when using height2 indexed,the incidence of left atrial dilatation is significantly higher.Therefore,the index method for left atrial dilatation in Chinese population needs to be explored.