The Study On Strain Rate Of Left Ventricular Myocardial Remodeling In Early Period In Patients With Hypertension By Using VVI

ObjectiveTest longitudinal and circumferential strain rate of left ventricular (LV) myocardium remodeling in early period of primary hypertension (HT) patients using velocity vector imaging (VVI). To evaluate the value of VVI in the detection of left ventricular regional systolic and diastolic function at early stage of hypertension, prevent and reverse LV remodeling, reduce injury of hypertension to heart and prevent complicating disease.Methods125patients with HT (male80, female45, average age60.2±10.5years) except valvular heart disease, diabetes mellitus and cardiomyopathy as HT group.80age-and gender-matched normotensive healthy volunteers (male45, female35, average age59.0±9.5years) as the normal group. HT patients were divided into two groups according to Ganau categories with left ventricular mass index (LVMI) and relative wall thickness (RWT):normal geometry (group NG,80cases), concentric remodeling (group CR,45cases).Siemens Sequoia512equipment with4Vlc probe (frequency2.0～4.0MHz) and VVI sofeware were used.Echocardiographic examination was performed to acquire parameters including LV diameter, wall thickness, LV ejection fraction (LVEF), transmitral diastolic inflow velocities (E, A), VVI indexes including systolic, early and late diastolic longitudinal strain rate (SrL) in4-chamber view and systolic, early and late diastolic circumferential strain rate (SrC) in LV short-axis view.Results1. There were no significant difference in age, sex and heart rate among three groups (P>0.05). Systolic and diastolic blood pressure of NG and CR were significant higher than NC, no significant difference between NG and CR.2. LVIDd of CR higher than NG and NC; no difference between NC and NG.LVMI and RWT were significant difference among three groups, increased progressively from NC to CR.LVEF appeared no difference in three groups (P>0.05), E/A of CR lower than NC and NG (P<0.05). No significant difference was found between NC and NG.3. Left ventricular segmental longitudinal and circumferential strain rate curve in hypertensive patients were similar with the normal controls:the systolic single negative peak curve showed that systolic myocardial segmental ventricular wall shorten; the early and late diastolic double positive curve suggested that diastolic myocardial segmental ventricular wall elongation.4. The basal segment, middle section and apical segment of left ventricular systolic SrL comparison among three groups:the middle segment of systolic SrL of CR lower than NC (P<0.05), there were no difference in the rest of segments.5. The basal segment, middle segment and apical segment early diastolic SrL comparison among three groups:the basal and middle segment of CR lower than NC (P<0.05), middle segment of CR lower than NG (P<0.05), middle segment of NG lower than NC (P<0.05). Apical segment of early diastolic SrL showed no significant difference among three groups. The lately diastolic SrL appeared no difference in three groups (p>0.05).6. Systolic, early diastolic and lately diastolic SrC of the basal segment, middle segment and apical segment appeared no difference among three groups (P>0.05).7. Six segment peak systolic SrC comparison in papillary muscle level:anterior septum and posterior septum of CR lower than NG and NC, there were no difference in the rest of segments.8. Six segment early diastolic SrC comparison in papillary muscle level: anterior septum, posterior septum, anterior wall and inferior wall in CR group had appreciably lower than NC(P<0.05), anterior septum, posterior septum and inferior wall in CR group lower than NG (P<0.05), only anterior septum, posterior septum in NG group had lower early diastolic SrC than NC group (P<0.05).lately diastolic SrC of six segment in papillary muscle level showed no difference among three groups.(P>0.05).Conclusions1. Although the LVMI of CR and NG was in the normal range, it was obviously higher than that of the compared group and increased progressively, illustrated that left ventricular myocardial remodeling had initiated in early period.2. SrL of LV myocardial remodeling in early period had decreased with normal LVEF showed that systolic SrL could reflect internal systolic character of LV myocardium better.3. Left ventricular diastolic dysfunction in Hypertensive Individuals would be underestimating if only measured by transmitral diastolic inflow. VVI may have more advantages in non-invasive reaction of regional myocardial function.4. VVI detected the decrease of systolic and early diastolic SrL in the basal and middle segment earlier than SrC of LV myocardium remodeling in early period of HT, Apical segment showed no significant difference probably because of characteristic of formation and arrangement of myocardial fibers.5. Integral SrC of the middle section had no significant difference in early period of left ventricular myocardial remodeling in patients with hypertension, but the regional myocardial SrC has decreased, diastolic dysfunction appeared ahead of systolic dysfunction.6. Degree of LV myocardium remodeling in HT was not uniform. Regularity of distribution probably depended on load of each segment of LV. in particular phase of motion of LV myocardium, particular segment would play a primary or secondary role in harmony.