The Impact Of Prehypertension On Left Ventricular Systolic Function Assessed By Real-time Three-dimensional Speckle Tracking Echocardiography

Objective:To assess the clinical value of left ventricular global systolic function in subjects with prehypertension, using three-dimensional echocardiography strain analysis.Methods:We enrolled 155 subjects who were referred to Taigang hospital physical examination center and outpatient clinic as part of screening program for primary prevention of cardiovascular diseases. Exclusion criteria were age >60 years, clinic BP>160/100 mm Hg, previous antihypertension treatment, white-coat hypertension, heart failure, coronary heart disease, previous cerebrovascular events, atrial fibrillation,congenital heart disease, valvular heart disease, obesity, neoplastic disease, cirrhosis of the liver, sleeping disorders, or endocrinological diseases including type 2 diabetes mellitus. 9 cases were excluded by poor apical acoustic window of two-dimensional or three-dimensional echocardiography which can not display LV endocardial or epicardial border. The enrolled subjects were grouped according guideline of JNC7. This study included 53 subjects with optimal blood pressure(SBP<120mm Hg and DBP<80mm Hg),47 subjects with perhypertension(SBP120-139 mm Hg, DBP80-89 mm Hg), 46 newly diagnosed untreated hypertension(SBP140-159 mm Hg, DBP90-99 mm Hg) patients matched by gender and age. Using a GE Vivid E9 ultrasound machine, all the subjects underwent blood pressure and traditional 2D echocardiography examination, tissue doppler examination, 3D echocardiography examination which were automaticallycalculated by the software. 3D data set acquisitions including: global longitudinal strain(GLS), global circumferential strain(GCS), global radial strain(GRS), global area strain(GAS). Bonferroni post hoc analysis was used to detect differences between the four group strain. Pearson’s correlation coefficient was used for determining the correlation between different 3D global deformation parameters and left ventricular mass(LVM), ejection fraction(EF), left ventricular Tei index. Inter- and interobserver variability for 3D LV deformation parameters were analyzed in 20 study subjects using Bland-Altman method.Results:3D global deformation strain were lower in the prehypertension group and the hypertension patients,in comparison with optimal blood pressure group,GLS:-17.8±2.0vs.-15.3±3.0vs.-14.9±2.8(P<0.01);GCS:-19.3±1.9vs.-16.8±3.2vs.-15.1±2.8(P<0.01);GRS:47.7±7.5vs.41.6±9.2vs.38.8±10.9(P<0.01);GAS:-30.5±4.2vs.-27.0±6.4vs.-26.8±4.3(P<0.01);而GCS在各两组之间均有统计学差异(P均<0.01).Bland-Altman analysis showed that 3D strain values have well reproducibility.Conclusion:3D echocardiography revealed the minimal change of subjects with prehypertension,providing value for therapy.