Quantitative Evaluation Of The Left Ventricular Remodeling And Systolic Synchrony In Patients With Essential Hypertension By Real-time Three-dimensional Echocardiography

BackgroundHypertension is the cause and risk factor for cardiovascular events andcardiovascular disease deaths. With the continuing increase inarterial pressure, burden on the heart has increased,which causeventricular remodeling.Such as ventricular myocardialhypertrophy,left ventricular concentric or eccentric hypertrophy.Hypertensive patients with left ventricular hypertrophy also knownas hypertensive heart disease. The development of ventricularremodeling can seriously affect cardiac diastolic and systolicfunction, eventually leading to heart failure. Patients with heartfailure often have the phenomenon of cardiac mechanicaldyssynchrony.There may have a synergistic effect betweendyssynchrony and low left ventricular systolic function.Both of themwork together to promote the progressive deterioration of cardiacfunction, so that the reconstruction is more obvious. Therefore, it isimportant to accurately evaluate left ventricular remodeling andsystolic hypertension synchrony for clinical diagnosis anddevelopment of treatment strategies. In this study, the left ventricularremodeling and systolic synchrony in patients with essentialhypertension was quantitatively evaluated by real-timethree-dimensional echocardiography (RT-3DE),andthe correlation between the two types of indicators was investigated.ObjectiveTo evaluate left ventricular remodeling and systolic synchrony in patientswith essential hypertension quantitatively by Real-timethree-dimensional echocardiography (RT-3DE), and to explore thecorrelation between the two.Methods30healthy volunteers and102patients with essential hypertension wereselected, including34cases of normal geometry,34cases ofconcentrichypertrophy,34cases of eccentric hypertrophy. RT-3DE wasused to measure its left ventricularend-diastolic volume(LVEDV),leftventricularend-systolic volume(LVESV),left ventricular ejectionfraction(LVEF),left ventricularmass index(LVMI),leftventricularremodeling index(LVRI), the standard deviation(Systolicdyssynchrony index, SDI) and the maximum difference(Tmsv16-Dif%) of left ventricular16segment systolic volume peaktime respectively. Relevant differences were analyzed andcompared,and correlation analysis was performed betweenparametersof left ventricular remodeling and synchronizationindex.Results1．Compared with conventional ultrasound parameters：age, heart rate, bodysurface area (BSA) showed no significant difference between eachconfiguration hypertension group compared and the control group(P＞0.05).The QRS wave of eccentric hypertrophy group is wider than theother three groups(P＜0.05), but the latter groups pairwisecomparisons showed no significant difference. There was nosignificant difference between normal control group and normal geometry group(P＜0.05). Compared with normal control group andnormal geometry group, the LVIDd, IVSd, LVPWd of concentrichypertrophy group and eccentric hypertrophy group increased(P<0.05). The LVIDd and LVIDs of eccentric hypertrophy group werelarger than concentric hypertrophy group (P<0.05), the IVSd andLVPWd had no significant difference(P＞0.05).2．Comparison of various parameters RT-3DE: Compared with normalcontrol group, in addition to the SDI of normal geometry groupincreased (P<0.05), in addition to the LVEDV, LVESV, LVEF ofconcentric hypertrophy group, the remaining parameters wereincreased (P<0.05). In addition to the LVRI of eccentric hypertrophygroup, the remaining parameters were larger than normal control group(P<0.05). Compared with normal geometry group, the SDI,Tmsv16-Dif%, LVMI, LVRI of Concentric hypertrophy group wereincreased (P<0.05). In addition to the LVRI of eccentric hypertrophygroup, the remaining parameters were larger than normal control group(P<0.05). The LVRI of eccentric hypertrophy group was reduced(P<0.05), the remaining parameters were larger than concentrichypertrophy group(P<0.05).3．SDI and Tmsv16-Dif%had positive correlation with LVEDV, LVESVand LVMI respectively (r=0.674,0.692,0.656and0.606,0.615,0.602,allP<0.01),and had negative correlation with LVEF(r=-0.56and-0.49,allP<0.01),and had no significant correlation with LVRI.4．The two intuitive " bull’s-eye diagram " shows that anterior septal andposterior septalcontraction delay and activity weakened by the patientsin hypertrophy group. It was maybe related to reconstruction of cardiachypertrophy. Conclusion1．Hypertension for a long time can changes the function and structure ofcardiac, such as wall thicken, cardiac chamber enlargement, cardiacejection reduce. Left ventricular remodeling index is very important todetermine the disease progression and prognosis of hypertensionpatients.2， Hypertensive patients may present different degrees of leftventricular remodeling and wall motion dyssynchrony.With thedevelopment of left ventricular remodeling, left ventricular systolicdyssynchrony increases.3．RT-3DE can accurately measure the volume of the volume, function,LVMI and LVRI, assess the extent of different pathological conditionsventricular remodeling. SDI and Tmsv16-Dif%may partly reflect thesituation of ventricular contraction dyssynchrony.