Abnormal Segmental Relaxation Patterns In Hypertensive Disease And Symptomatic Diastolic Dysfunction Detected By Strain Echocardiography

Backgroud and Objective An abnormal segmental relaxation pattern exists as an early sign of diastolic dysfunction(DD), detectable by strain(S)echocardiography.The objective of this study was to investigate the relation of segmental relaxation patterns with longitudinal systolic function and symptomatic DD in patients with hypertension(HTN).Methods We retrospectively analyzed 78 patients with essential HTN who met the inclusion criteria. Were recruited from the HTN outpatient clinic and the echocardiography department from Jan. 2014 to June 2014. And 30 healthy volunteers were also recruited as control subjects. All participants were evaluated for global DD, Early and late diastolic SR parameters(SRE and SRA) were also recorded from the basal, mid, and apical segments for each wall. Altered segmental relaxation(SRE/SRA < 1.1) was regarded as an index of segmental DD.Results Segmental DD was correlated with structural changes of left ventricular(LV) remodeling such as wall thickness(r:0.64), relative wall thickness(r:0.58), and LV mass index(r:0.59), as well as mean S(r:-0.61), SR(r:-0.62), systolic blood pressure(r:0.44), age(r:0.49), and filling pressures(r: 0.50), all P less than0.01.Segmental DD and systolic blood pressure were independently related to symptomatic status(segmental DD: ?=0.33, P =0.003; systolic blood pressure:?=0.24,P=0.009, R2:0.33). Compared with conventional indices of DD(deceleration time of the E wave, isovolumic relaxation time, E, A, and E/A), segmental DD was the only parameter that predicted symptomatic status(coefficient: 0.3817, SE: 0.1101,P = 0.0005, odds ratio:1.4648, 95% confidence interval: 1.1761-1.7485).Conclusions LV segmental relaxation demonstrates progressive deterioration in HTN disease, which is more pronounced in patients with symptomatic DD. Altered segmental relaxation is related to structural changes of LV remodeling and constitutes an independent predictor for the presence of a symptomatic status.