The Detection Of Global And Regional Cardiac Function In Hypertensive Patients With Different Left Ventricular Geometric Patterns By Use Of PW-DTI

Objective:To explore the essential hypertension patients with different left ventricular geometric models, the global and regional of the left ventricular systolic and diastolic function changesMethods:109 patients with essential hypertension, according to left ventricular mass index (LVMI) and relative wall thickness (RWT), were divided into four groups according to the severity of left ventricular remodeling:groupⅠ(45 patients with normal configuration), groupⅡ(33 patients with concentric remodeling), groupⅢ(15 patients with concentric hypertrophy), groupⅣ(16 patients with eccentric hypertrophy).30 healthy persons were Selected as the control group. Left ventricular end diastolic diameter (LVEDD), interventricular septum diastolic thickness (IVSD), left ventricular end diastolic posterior wall thickness (LVPWD), mitral flow peak velocity of early diastolic left ventricular filling (E),and late diastolic filling peak velocity (A) were measured by the conventional ultrasound,and then calculated the E/A ratio; Pulsed wave Doppler Tissue Imaging (PW-DTI) was used to measure the following indexes:systolic peak velocity (Sm), early diastolic motion velocity (Em) and late diastolic motion velocity (Am) of the six sites of the mitral annular. The six sites included the posterior wall, the anterior septum, the posterior septum, the lateral wall, the anterior wall and the inferior wall. Furthermore, the Em/Am ratio, E/ Em ratio and the average of the six sites of the indexes above were calculated. After that, the measurements and the calculated values among the groups were compared and analyzed.Results:1.The global cardiac function of left ventricular:①. Diastolic function:the average mitral flow E/A ratios of group I and groupⅡin Hypertension were<1 (0.98±0.31.0.98±0.52); the E/A ratios of groupⅢand groupⅣwere> 1(1.18±0.64,1.52±0.80):PW-DTI parameters:the Em/Am ratios of the all groups of hypertension were significantly lower than those in the control group (respectively were:0.81±0.29.0.77±0.24.0.64±0.09.0.79±0.21,p <0.05); the E/Em ratios were significantly greater than those in the control group (p<0.05).The Em/Am of the groupⅢwas significantly lower than those of groupⅠandⅡ; the E/Em ratios of the groupⅢandⅣwere significantly lower than those of groupⅠandⅡ.②. Systolic function:The Sms of groupⅢand groupⅣwere significantly lower than those in the control group, groupⅠandⅡ(p <0.05),2. the cardiac function of each segment in left ventricular:①Diastolic function parameters:the Em/Am ratios of the six sites in each group of hypertension were significantly lower than those in the control group (p<0.05), the E/Em ratios were significantly higher than the control group(p<0.05).②Systolic function parameters:the Sms of six sites in groupⅢ,Ⅳwere significantly lower than those in the control group (p<0.05), the Sm of some segments in groupⅠandⅡwere lower than those in the corresponding segment of the control group's (p<0.05)3.The degree of impairment of cardiac function in different segments:①Diastolic function parameter:the rate of E/Em of lateral, anterior. inferior wall increased significantly more than those in the posterior wall and the interval wall.②Systolic function parameter:the rate of Sm of lateral wall and anterior wall reduced significantly more than those in the posterior wall,the anterior septum wall and the inferor wall.4.The correction analysis of the cardiac function parameters with the severity of the left ventricular remodeling:①Left ventricular pattern from normal geometry concerntric remodeling to concentric hypertrophy and eccentric hypertrophy in turn was assigned to 1,2,3,4, representing the degree of the left ventricular remodeling,which was from light to heavy.LVEF and Sm were negatively correlated with left ventricular configuration (r=-0.232,-0.476); the E/Em ratio was positively correlated with left ventricular configuration (r= 0.302).②The analysis of the correction between LVMI and the cardiac function parameters:LVEF and Sm were negatively correlated with LVMI ( r=-0.232,-0.524),E/Em was positively correlated with LVMI(r=0.410).Conclusion:l.The Pulsed wave Doppler Tissue Imaging(PW-DTI)could assess the globe and local cardiac function better. 2.The global and regional damage of diastolic function occurred in the essential hypertensive patients when the shape of the left ventricular was normal, and accompanied with regional systolic dysfunction. As the myocardial remodeling of the left ventricular progressed to the stage of concentric hypertrophy and eccentric hypertrophy, the global systolic dysfunction the left ventricular appeared. 3.The progression of each segment cardiac function impairment in the patients with essential hypertension may be heterogeous.