Evaluation Of The Effect Of Blood Pressure Control On Left Ventricular Systolic Function In Hypertensive Patients By Three-dimensional Speckle Tracking Imaging

Objective: The most common cardiac dysfunction in hypertensive disease is left ventricular diastolic dysfunction.However,recent studies have found that left ventricular systolic function has been impaired in hypertensive patients before left ventricular ejection fraction(LVEF)reduced.The left ventricular systolic function of hypertensive patients with different blood pressure control levels has not been defined clearly and there are few researchers.In this study,we selected hypertensive patients with normal LVEF levels and different blood pressure control levels.And three-dimensional speckle tracking imaging(3D-STI)technique was used to early evaluate the impairment of left ventricular systolic function in hypertensive patients.Methods: This cross-sectional study consisted of 140 grade 2 hypertensive patients admitted to our hospital from 2017 to 2018.According to the blood pressure control levels,they were divided into three groups:45 consecutive patients without a medication for arterial hypertension(group A),50 treated patients with well-controlled hypertension(group B),45 treated subjects with uncontrolled hypertension(group C).In addition,30 sex and age matched subjects with normal blood pressure were selected as the control group.All subjects underwent office blood pressure measurement after admission at least three times.Average systolic blood pressure and diastolic blood pressure were recorded.All subjects underwent echocardiography to obtain two-dimensional ultrasound parameters such as inter-ventricular septum and LV posterior wall thickness,relative wall thickness,left atrial volume index;three-dimensional ultrasound parameters such as left ventricular end-diastolic volume,left ventricular end-systolic volume,LVEF and left ventricular mass index(LVMI);3D-STI parameters such as global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),LV twist angle,LV torsion,left ventricular global time to peak(TTP).The frequency and magnitude of impaired myocardium deformation was determined respectively in 3 hypertensive subgroups.And the clinical and echocardiography parameters related to myocardium strain were investigated.Results:(1)GLS and GCS were not only significantly lower in the group A,C,or group B than controls,but also significantly decreased in the group A and C compared with group B(P(27)0.05).GRS was significantly decreased in the group A and C compared with controls(P(27)0.05).However,there were no differences between group A and C about GLS,GCS and GRS(P>0.05).Compared to controls,LV twist angle and torsion significantly increased in hypertensive patients — especially in group A and C(P(27)0.05).There were no differences between group A and C about LV twist angle and torsion(P>0.05).(2)Among the 3orthogonal strain values,intra-group comparison found that the prevalence of GLS abnormal was the highest and comparison among groups found that group B had the lowest incidence of impaired strain values.(3)In group A,correlation analysis found that GLS was associated with systolic blood pressure,LVMI,and BMI(r = 0.64,0.49,0.37,respectively,P(27)0.05).In the C group,correlation analysis found that GLS was associated with systolic blood pressure,LVMI,BMI,and duration of hypertension(r=0.68,0.45,0.42,0.52,respectively,P<0.05).Multiple linear regression analysis of GLS in group A and group C showed that systolic blood pressure and LVMI have an significant effect on the reduction of GLS(group A:?=0.680,0.472,P=0.000,0.004;group C:?=0.684,0.452,P=0.000,0.006).And systolic blood pressure has the most significant effect on GLS reduction.Conclusions: 3D-STI technology can detect changes in left ventricular systolic function early.The left ventricular systolic function of hypertensive patients with different blood pressure control levels is significantly different.Compared with the control group,left ventricular systolic function was slightly impaired in treated patients with well-controlled hypertension,and left ventricular systolic function was severely impaired in untreated and treated subjects with uncontrolled hypertension.