| Backgrounds and ObjectivesStudies on left ventricular(LV) myocardial systolic deformation at different stages of hypertensive heart failure is important for understanding the hemodynamic mechanism of its occurrence and development as well as the prognosis. The pathophysiological process and LV remodeling together with cilinical manifestation of hypertensive heart failure is consecutive. Our previous study has found that SL decreased dominantly at early stage of LV remodeling, and SL, SC and SR were all significantly impaired when hypertrophy occurred. This study aimed to investigate myocardial multi-dimensional systolic deformation in hypertensive with different LV ejection fraction(LVEF), and to explore the contribution of systolic myocardial multi-dimensional deformation on LVEF.Methods123 patients(male 96, female 27, average age 57.35±12.74 years) with primary hypertension were enrolled as the HT group. 21 age- and gender- matched healthy volunteers(male 13, female 8, average age 52.81±8.89 years) as the normal control group(NC). HT patients were divided into three groups based on LVEF and LVEDVI: group A( LVEF ≥ 55%, LVEDVI < 97ml/m2, n=71), group B( 45% ≤LVEF < 50%, or 50% ≤ LVEF < 55% and LVEDVI ≥ 97ml/m2, n=13), and group C(LVEF<45%, n=34). Echocardiographic examination was performed to acquire conventional parameters including LV diameter, ventricular wall thickness,LVEF(by area-length method), transmitral diastolic inflow velocities(E, A), mitral annuluar systolic, early, late diastolic velocities(s, e, a), E/A, E/e, and 2DSE measurements including endsystolic LV longitudinal strain(SL), radial strain at 3 levels(SR-mv, SR-pm, SR-ap), circumferential strain at 3 levels(SC-mv, SC-pm,SC-ap), rotation angle(Rot-mv, Rot-ap) and twist angle(Twist).Results1. All the 2DSE measurements were decreased in the whole HT group, among them SL, SC-mv, SC-pm were decreased significantly(p<0.05).2. In the 3 subgroups of HT, SL decreased in group A [A:(-18.42±3.85)% vs NC:(-21.44±1.97)%, p < 0.05], and progressively in group B and C(p < 0.05 between each 2 groups); SR and SC decreased significantly in group B, down further in group C(p<0.05 within 3 groups) [SR: A:(41.62 ± 14.83)%, B:(-27.87± 11.91)%, C:(-19.76 ± 7.85)%; SC: A:(-18.00 ± 3.26)%, B:(-15.12 ± 3.62)%, C :(-9.51 ± 2.90) %]; and inclined Twist was only occurred in group C [ C:(14.81 ±4.70)% vs A:(22.49 ± 6.14)%, p<0.05].3. There were strong correlation between LVEF and SL, SC, SR, Twist, with stronger correlation to SC and SL(r=0.82、0.76,p<0.01).4. Using receiver operating characteristic curve analysis, SC 、 SL、 SR all showed good abilities to predict a decreased LVEF(<50%), and a SC-mv of ≤-13.82%(sensitivity 82%, specificity 89%) and a SC-pm of ≤-15.52%(sensitivity91%, specificity 82%) were identified as the best cutoff values to be associated with a decreased LVEF, and the index SC was considered more reliable than SL and SR(AUC: SC: 0.90-0.91,SL: 0.89, SR: 0.88).5. In the three sub-HT groups the index of diastolic function showed a processing alteration: decreasing e, increasing LAD and E/e, within a significant difference between any two groups.Conclusions1. Diastolic function and SL abnormalities already existed on the early stage of hypertension heart failure with normal LVEF, while SC, SR and Twist were preserved; The deteriorating of myocardial multi-deformation caused left ventricular pump failure with a significant reduced LVEF, and diastolic function showed further deterioration at the same stage, indicating a deleterious cardiac disorder with both systolic and diastolic dysfunction.2. The multi-deformation were correlated with LVEF, and there was a most highly correlation between SC and LVEF, suggesting SC may play a decisive role in the preserving or decreasing of pump function. |
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