Evaluation Of Left Ventricular Systolic Function In Essential Hypertensive Patients By Layer-specific Two-dimensional Speckle Tracking Imaging

Objective In this study,two-dimensional speckle tracking layer-specific strain image was used to quantificationally assess the systolic function of left ventricular myocardium in patients with essential hypertension,which offer scientific basis for early detection of subclinical myocardial damage in patients with EHP and timely intervention to improve the prognosis.method There were 63 patients confirmed EHP in Central Hospital Affiliated to College from December 2021 to June 2022 and chosen.They were separated into two groups on the bases of LVMI,that is,non-left ventricular hypertrophy group(NLVH group)and left ventricular hypertrophy group(LVH group).Besides,a control group of 30 agematched healthy volunteers were collected,none of those has a history of heart problems such as hypertension and coronary heart disease.All subjects were checked by routine echocardiography.In the parasternal left ventricular long-axis section inter-ventricular septal thickness(IVST),left ventricular end-diastolic diameter(LVDd),left ventricular posterior wall thickness(LVPWT),left atrial diameter(LAD)and left ventricular ejection fraction(LVEF)were measured and recorded.Then left ventricular mass index(LVMI)were naturally obtained.Three-dimensional full-automatic volume quantification technique was used to measure left atrial volume(LAV)at end-systolic. Two-dimensional dynamic images of three apical views and left ventricular mitral valve,papillary muscle,and apical level short-axis views were imported into QLAB-CMQ software for analysis.Then the peak systolic longitudinal strain values and circumferential strain values(LS,CS)of the three-layer myocardium and the global systolic strain were obtained.The strain gradients(LSendo-epi、CSendo-epi)from endocardial layer to epicardial layer were calculated.The differences of conventional ultrasonic parameters and left ventricular strain parameters among the three groups were compared and analyzed.result 1.Comparison of general information: the differences in age,height,body weight,body mass index and body surface area among the three groups were not statistically significant(P > 0.05).Systolic and diastolic blood pressure were increased in NLVH group and LVH group compared with control group(P < 0.05).The difference of systolic and diastolic blood pressure between NLVH group and LVH group was not significant(P > 0.05).2.Comparison of conventional echocardiogram parameters: LVPWT and LVMI increased gradually from control group to NLVH group and then to LVH group(P < 0.05);Compared with control group and NLVH group,IVST,LVDd,LAD and LAV in LVH group were increased(P < 0.05).The difference in IVST,LVDd,LAD and LAV between NLVH group and control group do not reach statistical significance(P > 0.05).No difference was found in LVEF among the three groups(P > 0.05).3.Comparison of myocardial stratified strain parameters: LS and CS decreased layer by layer from endocardial to epicardial layer in control group,NLVH group and LVH group,namely subendocardial layer < middle myocardial layer < subepicardial layer(P < 0.05).Compared with the control group,LSendo、LSmid、GLS and LSendo-epi were decreased in the NLVH group,and LSendo、LSmid、LSepi、GLS and LSendo-epi were decreased in the LVH group(P < 0.05).Compared with NLVH group,LSendo、LSmid、LSepi and GLS in LVH group were decreased(P < 0.05).The LSendo-epi between NLVH group and LVH group do not differ significantly(P > 0.05).Compared with the control group,CSendo、CSmid、GCS and CSendo-epi were decreased in the NLVH group(P < 0.05),and CSendo、CSmid、CSepi、GCS and CSendo-epi were decreased in the LVH group(P < 0.05).Compared with NLVH group,CSendo、CSmid、CSepi、GCS and CSendo-epi were lower in LVH group(P < 0.05).conclusion Even if LVEF remained normal and left ventricle morphology had little change,myocardial systolic function in hypertensive patients was impaired,which was manifested by the decline of left ventricular longitudinal and circumferential strains in the inner and middle myocardium.When it progressed to LVH,both longitudinal and circumferential strains in the left ventricular three-layer myocardium were decreased.LSS can early detect subclinical myocardial function impairment and reflect the change of myocardial systolic function in hypertensive patients sensitively.