Evaluating Ventricular Function In Hypertensive Patients With Or Without Diabetes Mellitus By Real-time Three-Dimensional Echocardiography

Objective:To evaluate the changes of ventricular morphology and function in patients who suffer from hypertension (HBP) with or without diabetes mellitus (DM) by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI).Methods:One hundred and fifty-six hospitalized patients with HBP were enrolled from cardiology department of the Second Hospital of Tianjin Medical University, between April.2013-April.2014. Patients were divided into Group H (seventy-six cases, without DM) and Group H+D (eighty cases, with DM). Seventy-eight patients who were diagnosed no HBP or DM by medical history collection-. physical examination and blood glucose measurement, were enrolled as control group (Group N). The patients’ height, weight, heart rate, blood pressure, smoking/drinking history and the medical history of HBP and DM were recorded in detail. The blood lipid and glucose level were examed. All patients completed the echocardiography examination with Philips iE33. Datas measured by2DE were recorded, such as thickness of ventricual wall, diameter of chamber and the left ventricual ejection fraction (LVEF). Volume-time curves (VTCs) and illustration of the bull eye (IBE) were measured by QLAB3DQ Advanced software, The time to minimum systolic volume of16/12/6-segmental standard deviation (T-16-SD、T-12-SD、T-6-SD) and maximal difference (T-16-Dif、T-12-Dif、T-6-Dif), the time to minimum systolic volume of16/12/6-segmental standard deviation and maximal difference as a ratio of R-R interval (T-16-SD%、T-12-SD%、T-6-SD%、T-16-Dif%、T-12-Dif%、T-6-Dif%), the average excursion (E-Avg), the maximal excursion (E-Max), the minimal excursion (E-Min), the standard deviation of excursion (E-SD) were recorded. Right ventricule was measured by QLAB GI3DQ software with parameters as right ventricular end systolic volume (RVESV) and right ventricular end diastolic volume (RVEDV), then calcuting the right ventricular ejection fraction (RVEF).Got the tricuspid annular displacement with QLAB TMAD software. All clincal datas were statistically analyzed and processed by SPSS17.0.Results:1. There were higher blood pressure in Group H and Group H+D than that in Group N; The FBS level was much higer in Group H+D than that of Group N and Group H; There were lower level of high density lipoprotein cholesterol (HDLc) in Group H+D than Group N (P<0.05).2. The RVAW was thicker in Group H+D than that in Group N and Group H, while the IVST and LVPW were thicker in Group H and Group H+D than that in Group N (P<0.05).; The LAD was more larger in Group H+D than that in Group N and Group H. The LVEF were lower in Group H+D than that in Group N and Group H. There were a higher percentage of the left ventricular hypertrophy>. valve calcification and decreased left ventricular diastolic function in Group H and Group H+D than those in Group N (P<0.05).3. The T-12-Dif%and T-6-Dif%in Group H and Group H+D were smaller than that in Group N (P<0.05).4. The VTCs of patients in Group N just like the parabolic curves, distributed regularly, with a big amplitude and undulating consistently in different segment. The VTCs of patients in Group H distributed unevenly with a irregular shape. The VTCs of patients in Group H+D distributed more unevenly with more irregular shape.5. The E-SD and E-Max in Group H+D were larger than those in Group N. The E-SD in Group were larger than those in Group N (P<0.05).6. The time/excursion-IBE of patients in Group N, with well-distributed green/blue, while those of Group H and Group H+D showed a mixed colour with red, blue or black, and it was more mixture in Group H+D.7. There were bigger RVESV and smaller RVEF in Group H and Group H+D than those in Group N (P<0.05).8. The TMAD-1, TMAD-2, TMAD-M, RVFS in Group H+D was smaller than those in Group N and Group H (P<0.05).9.RVEF got positively correlated with LVEF (r=0.162, P<0.05).Conclusions:1. RT-3DE could be well used to evaluate the left ventricular morphology and function. HBP and DM showed synergistic effect in reducing left ventricular systolic function.2. Both irregular VTCs and inhomogeneous IBEs with the ability to assess the contraction synchrony of ventricular wall, and they can point out the abnormalities of wall motion that can not be easily discovered by2DE in patients with HBP or DM.3. RT-3DE also could be well used to evaluate the right ventricular morphology and function. The right ventricular function showed decrease in the patients with HBP and they had a much more declined in patients with HBP and DM.4. To some degree, TAD was reliable to estimate the right ventricular systolic function with poor image quality.5. RVEF showed a positive correlation with LVEF (r=0.162, P<0.05), both of which were parameters that reflect the whole systolic functions of ventricles, which indicated that right ventricular function changes as the left does.6. Changes of ventricular morphology and function can be discovered in patients with HBP or DM earlier by synthetic application of different ultrasonic technologies. The sample size should be enlarged and further research is needed.