| Part 1 Noninvasive pressure-strain loop was used to evaluate left ventricular work in essential hypertensionPurpose:To investigate the clinical value of non-invasive pressure strain ring（PSL）in evaluating left ventricular myocardial work in patients with essential hypertension.Methods:Sixty patients with hypertension who were admitted to Yangzhou University Affiliated Hospital from August 2020 to July 2021 were prospectively collected.They were divided into mild group（140mmHg≤SBP<160mmHg and/or 90mmHg≤DBP<100mmHg,35 cases）and moderate to severe group（SBP≥160mmhg and/or DBP≥100mmHg,25 cases）Another 40 healthy adults were collected as control group.All subjects were measured for height,weight,blood pressure and underwent routine echocardiography and speckle tracking imaging analysis.The differences of general clinical data,two-dimensional ultrasound basic parameters,left ventricular long axis strain（GLS）,left ventricular peak strain dispersion（PSD）and myocardial work parameters,including global work index（GWI）,global constructive work（GCW）,global wasted work（GWW）and global work efficiency（GWE）,were compared among the three groups.Receiver operating characteristic curve（ROC）was used to evaluate the parameters and determine the optimal truncation value of each parameter.In addition,the myocardial work index（MWI）and the proportion of MWI in apex,middle and base of the three groups were compared.Results:1.There were no statistically significant differences in GLS and GWE among the three groups（X2-1.559、5.849,P>0.05）,while there were statistically significant differences in PSD,GWI,GC W and G WW among the three groups（X2=57.605、79.203、76.973、17.429,P<0.05）.2.Compared with the control group,PSD,GWI,GCW and GWW of mild hypertension group and moderate/severe hypertension group were increased,with statistical significance（P<0.05）;Compared with mild hypertension group,PSD,GWI and GCW were increased in moderate/severe hypertension group,and the difference was statistically significant（P<0.05）,while GWW was increased,but the difference was not statistically significant（P>0.05）.3.The areas under ROC curve for diagnosing hypertension by GWI,GCW,GWW and PSD were 0.978,0.980,0.735 and 0.937,respectively.The optimal cut-off values were 2092mmhg%,2383.5 MMHG%,101.5 MMHG%and 38.5msec,respectively.The corresponding sensitivity was 90.0%,95.0%,63.3%,94.0%,and the specificity was 97.5%,92.5%,82.5%,82.5%,respectively.4.MWI at the apex,middle and base of the heart showed an increasing trend in the control group,mild hypertension group and moderate/severe hypertension group,and the differences among the three groups were statistically significant（F=107.361,80.368,52.964,P<0.05）.5.The proportion of MWI in apex of heart showed an increasing trend in control group,mild hypertension group and moderate/severe hypertension group,and the difference was statistically significant（F=11.230,P<0.05）.The proportion of basal MWI in the three groups showed a decreasing trend,and the difference was statistically significant（F=10.665,P<0.05）.There was no significant difference in the proportion of middle MWI among the three groups（F=0.593,P>0.05）.Conclusion:Non-invasive PSL is a promising new technique,and its myocardial work index is more sensitive than speck-tracking GLS,providing a new method for quantitative evaluation of left ventricular systolic function in patients with varying degrees of hypertension.Part 2 Evaluation of left ventricular work in prehypertensive patients by noninvasive pressure strain techniqueObjective:To investigate the clinical value of non-invasive pressure strain loop technique（PSL）in evaluating left ventricular myocardial work in pre-hypertension（Pre-HT）.Methods:Prospectively collected in July 1,2021 in yangzhou university hospital line echocardiography of 34 patients with hypertension grade I as hypertension grade I group（HT-I group）,24 patients with prehypertension as prehypertension group（pre-HT group）,and 20 cases of normal blood pressure of physical examination as a control.The clinical data,conventional parameters of echocardiography,longitudinal peak strain dispersion（PSD）and myocardial work（MW）parameters were compared among the three groups.The myocardial work parameters included global work index（GWI）,global constructive effort（GCW）,global wasted effort（GWW）,and global work efficiency（GWE）.The correlation between myocardial work parameters and left ventricular systolic function parameters was analyzed.Result:1.There were significant differences in E/A and E/E ’among the three groups（F=69.23,3.21,P<0.05）.There were significant differences in E/A value between control group and HT-I group,pre-HT group and HT-I group（P<0.05）,and there were significant differences in E/e ’value between control group and HT-I group（P<0.05）.2.There was no significant difference in GLS and GWE among the three groups（X 2=5.621、.967,P>0.05）,The differences of GWI,GCW,GWW and PSD among the three groups were statistically significant（X2=49.0、51.9、9.7、39.7,P<0.05）.With the increase of blood pressure,GWI,GCW,GWW and PSD increased gradually.There were statistically significant differences in GCW and PSD among the three groups（P<0.05）,there were statistically significant differences in GWI between HT-I group and control group,HT-I group and pre-HT group（P<0.05）,and there were statistically significant differences in GWW between control group and HT-I group（P<0.05）.3.In pre-HT group,GWI was positively correlated with systolic blood pressure（r=0.504,P=0.014<0.05）,GCW was negatively correlated with GLS（r=-0.629,P=0.001<0.05）,GWW was positively correlated with PSD（r=0.763,P=0.000<0.05）,GWE was negatively correlated with PSD r=-0.722,P=0.000<0.05).Conclusion:Non-invasive PSL technique can be used to assess early abnormal myocardial systolic function in patients with pre-HT,and left ventricular GCW is significantly increased in patients with pre-HT,which is highly correlated with GLS,a parameter reflecting left ventricular systolic function. |
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