Assessment Of Left Ventricular Twist And Untwist In Patients With Different Patterns Of Essential Hypertension Using Speckle Tracking Imaging Echocardiography

Objective:To calculate left ventricular rotation and twist with different patterns of essential hypertension patients by two-dimensional speckle tracking imaging(2D-STI),and to obtain the left ventricular torsion and prot-untwisting velocity,and to analyze torsional dynamic changes in the process of left ventricular remodeling of left ventricle in patients with EH,to investigate the value of speckle tracking imaging in the evaluation of cardiac function.Methods:170 EH patients and 50 healthy control subjects were included.Systolic blood pressure(SBP),diastolic blood pressure(DBP)and body mass index(BMI)were measured in all subjects.In the parasternal long axis view,the left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),thickness of inter-ventricular septum(IVST)and left ventricular posterior wall thickness(LVPWT)were measured,and calculate the left ventricular mass index(LVMI)and relative wall thickness(RWT).In the apical four chamber view,using pulsed Doppler measurement of mitral orifice flow,including E peak early diastolic and late diastolic peak A and deceleration time of DT,using tissue Doppler imaging measuring mitral annular early diastolic velocity Em and late diastolic velocity Am,and calculate the E/Em.In the apical four chamber and two chamber view,left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular stroke volume(LVSV)and left ventricular ejection fraction(LVEF)were measured using the Simpson method of double plane.Peak rotation on basal plane(Prot-base)and apical plane(Prot-apex),peak twist angle(Ptw)and prot-untwisting velocity(PUV)were measured by 2D-STI.Results:Compared with control group,left ventricular end systolic diameter and end diastolic diameter increased significantly in both concentric hypertrophy(CCH)group and eccentric hypertrophy(ECH)group(P < 0.01),comparison of the above two indexes between the two groups had significant differences(P<0.01);compared with control group,left ventricular mass index and relative wall thickness were significantly increased in both concentric remodeling(CCR)group and concentric hypertrophy(CCH)group(P<0.01),there was no significant difference between the two indexes(P>0.05);Compared with control group,the peak twist angle(Ptw)was significantly increased in concentric remodeling(CCR)group and concentric hypertrophy(CCH)group(P<0.01),the peak twist angle(Ptw)was decreased in eccentric hypertrophy(ECH)group(P<0.01).Regarding LV untwisting rate,compared with control group,the prot-untwisting velocity(PUV)was increased in concentric remodeling(CCR)and concentric hypertrophy(CCH)groups.In eccentric hypertrophy(ECH)group,there was no significant difference in prot-untwisting velocity(PUV)(P>0.05).Conclusion: 1.Enhanced LV twist appears to be a compensatory mechanism in EH patients during the earlier stages of concentric remodeling and concentric hypertrophy,this hyper-torsion is inevitably loss in the more advanced stage of eccentric hypertrophy.2.STI can analysis left ventricular torsion and untwisting with different grade and geometry of EH patients quantitatively,and can reflect the damage of the left ventricular function early and sensitively,providing a reliable theoretical basis for the prevention and treatment for EH patients.In a word,STI provides a new,noninvasive and accurate detection method for analysis of curative effect evaluation and prognosis of patients with hypertension.