Evaluation On The Early Changes Of Left Atrial Function In Patients With Primary Hypertension With Preserved Ejection Fraction By Two-dimensional Speckle Tracking Technique

Objective:Using Two-Dimensional Speckle Tracking Imaging to evaluate the early changes of left atrial function early in patients with primary hypertension with preserved ejection fraction.Methods:Totally 101 patients were diagnosed with stage 1 primary hypertension for the first time in our Hospital from August 2019 to August 2020,and the subjects were divided into two groups according to the recommendations which was from the American Society of Echocardiography and the European Association of Cardiovascular Imaging in 2016 year:the normal diastolic function group（n=53）included 29 males and24 females,mean age 49.8±7.3 years;the reduced diastolic function group（n=48）included 26 males and 22 females,mean age 50.6±7.7 years.In addition,healthy subjects（n=51）were selected as the control group,which included 28 males and 23females,mean age 52.1±8.2 years.The following conventional echocardiography parameters were measured:left ventricular ejection fraction（LVEF）,left atrial diameter（LAD）,mitral valve inflow peak spectral velocity in left ventricular early diastole（E-wave）,mitral valve inflow peak spectral velocity in left ventricular end diastole（A-wave）,the ratio of E-wave to A-wave（E/A）,maximum velocity of tricuspid regurgitation（TRVmax）,tissue velocity of mitral annulus on the ventricular septum in left ventricular early diastole（Sep e’）,tissue velocity of mitral annulus on the lateral wall in left ventricular early diastole（Lat e’）,left atrial volume index（LAVi）,average E/e’value（e’=（Sep e’+Lat e’）/2）.We analyzed all the ultrasound dynamic images offline,and measurd the peak atrial longitudinal strain during reservoir phase(PALS_res),the peak atrial longitudinal strain during conduit phase(PALS_cond),and the peak atrial longitudinal strain during booster pump phase(PALS_pump).We analyzed and compared general clinical data,conventional echocardiographic parameters and 2D-STI parameters among three groups.The ROC curve was drawn to evaluate the diagnostic efficacy of left atrial strain parameters in patients with primary hypertension.Results:1.Comparison of general clinical data:The differences in height,age,weight,gender,heart rate,BSA among the control group,the normal diastolic function group and the reduced diastolic function group were not statistically significant（P>0.05）;The differences in SBP、DBP between the control group and the normal diastolic function group were statistically significant（P<0.05）;The differences in SBP、DBP between the control group and the reduced diastolic function group were statistically significant（P<0.05）;The differences in SBP、DBP between the normal diastolic function group and the reduced diastolic function group were not statistically significant（P>0.05）.2.Comparison of conventional two-dimensional echocardiographic parameters:The differences in LVEF,LAD,LAVi,E-wave,A-wave,E/A,Sep e’,Lat e’,average E/e’and TRVmax between the control group and the normal diastolic function group were not statistically significant（P>0.05）;The differences in LVEF,LAD,LAVi,A-wave between the control group and the reduced diastolic function group were not statistically significant（P>0.05）,and the differences in E-wave,E/A,Sep e’,Lat e’,average E/e’,TRVmax between two groups were statistically significant（P<0.05）;The differences in LVEF,LAD,LAVi,A-wave between the normal diastolic function group and the reduced diastolic function group were not statistically significant（P>0.05）,and the differences in E-wave,E/A,Sep e’,Lat e’,average E/e’,TRVmax between two groups were statistically significant（P<0.05）.3.Comparison of 2D-STI parameters:PALS_resand PALS_condof the normal diastolic function group were lower than the control group,and PALS_pumpwas higher than the control group,all of which were statistically significant（P<0.001）;PALS_resand PALS_condof the reduced diastolic function group were lower than the control group,and PALS_pumpwas higher than the control group,all of which were statistically significant（P<0.001）;PALS_resand PALS_condof the reduced diastolic function group were lower than the normal diastolic function group,and PALS_pumpwas higher than the normal diastolic function group,all of which were statistically significant（P<0.001）.4.ROC curve of 2D-STI parameters:The ROC curve about evaluating left atrial function in patients with hypertension by 2D-STI parameters showed that the area under the curve were 0.869(PALS_res),0.817(PALS_cond)and 0.670(PALS_pump)respectively.Conclusion:The 2D-STI used in this study can detect the early changes in left atrial strain parameters and quantitatively assesse the early changes of left atrial function early in primary hypertension patients with preserved ejection fraction,and PALS_res、PALS_condwere anterior than PALS_pump.There is important clinical application value of 2D-STI in assessing the cardiac function of hypertensive patients as well as guiding early antihypertensive treatment.