Investigation On Left Ventricular Myocardial Systolic Function In Primary Hypertension By Two-dimensional Speckle Tracking Imaging

Objective Primary hypertension is mainly characterized by increased systemic arterial blood pressure. The impact on the heart is mainly to impair the myocardial systolic function due to left ventricular remodeling. This study aims to observe left ventricular myocardial strain and twist of multiple directions in the different geometric patterns of left ventricle by two-dimensional speckle tracking imaging and to preliminary discuss the relationship between different geometric patterns of left ventricle and myocardial systolic function in hypertension patients.Methods One hundred and thirty-two primary hypertensive patients with normal left ventricular ejection fraction, except for other diseases such as diabetes arrhythmia patients were selected in this study. Patients were divided into four groups based on Ganau classification:normal geometry group (NG group,38cases), concentric remodeling group (CR group,35cases), concentric hypertrophy group (CH group,31cases) and eccentric hypertrophy group (EH group,28cases). In addition,34cases of gender and age matched healthy volunteers were selected as normal control group.Echocardiographic examination was performed to acquire parameters of left ventricular:1. geometry parameters including wall thickness, left ventricular diameter;2. parameters of myocardial systolic function including regular indices:left ventricular ejection fraction (LVEF), short-axis fractional shortening (FS), and2DSE measurements: endsystolic LV longitudinal strain (SL), radial strain (SR), circumferential strain (SC), rotation angle (Rot) and twist angle (Twist).Results1. Compared with normal control group, patients in hypertension group (132cases) had larger wall thickness and weight, and the LVEF was in normal range. SL of hypertension group was significantly reduced in comparison with that of normal control group (P<0.05). There was no significant difference in SC of mitral valve or papillary muscle level, SR of papillary muscle level and left ventricular twist between the two groups.2. Compared with normal control group, SL was significantly reduced in NG group and CR group. There was no significant difference in SC and SR of mitral valve or papillary muscle level between normal control group and NG group or CR group. The SL, SC and SR of mitral valve or papillary muscle level in CH group and EH were significantly reduced in comprarison with NG group and CR group. SR of cardiac apex level shows:NG<CR<CH. However there was a slight reduction in SR of the EH group, but it was higher than normal control group. Twist of NG group and CR group were slightly higher than that of the normal control group. CH group and EH group had a similar Twist in comparison with normal control group.Conclusions Two-dimensional speckle tracking imaging can provide accurate parameters of ventrical wall motion of hypertension patients and identify slight difference of ventrical wall motion in the different geometric patterns of left ventricle: The pump function of hypertension patients can be kept normal, but the systolic function of myocardium has been impaired, leading to more or less reduction of strain values of different geometric patterns in different directions. The SL reduces before ventricular wall hypertrophy; The SL, SC, and SR of mitral valve or papillary muscle level all reduce after ventricular wall hypertrophy. In all geometric patterns, the SR of cardiac apex level shows an increase, but the variation of left ventricular twist is little. This may account for the normal pump function of left ventricle.