The Relationship Between Remodeling Index And Left Ventricular Diastolic Function In Essential Hypertensives

Background:Left ventricular diastolic dysfunction is one of the most common target organ damage in hypertension.Conventional index of cardiac geometry do not adequately predict the development of left ventricular diastolic dysfunction.We developed a novel Remodeling IndexRI)that was derived using LaPlace's Law,which describes the geometric relationship between LVEDV and wall thickness and it is proportionate to the left ventricular generated wall stress(??P·RI).LVEDV and interventricular septal thickness were used in the calculation of RI.It reflects that,under the same intra-LV pressure generated during passive filling,different left ventricular geometry patterns generates different meridional wall stress.Our retrospective study aimed to investigate the association between RI and left ventricular diastolic function in essential hypertensives.Methods:A total of 607 subjects(363 males and 244 females)were enrolled from the First Affiliated Hospital of Fujian Medical University from June 2015 to september2017,including 347 with essential hypertension(EH)and 260 with normal blood pressure.The subjects were stratified into left ventricular diatolic dysfunction(LVDD)group and no left ventricular diastolic dysfunction(NLVDD)Group based on Early diastolic transmitral velocities(E),average early diastolic annular velocities(?)and their ratio(E/?)measured and calculated based on two-dimensional and Doppler echocardiography.The clinical data and RI between LVDD group and NLVDD group was contrasted,and logistic analysis were performed to distinguish the related factors of left ventricular diastolic dysfunction.Results:1.A total of 607 subjects were enrolled in the study,including 180 with leftventricular diastolic dysfunction and 427 without left ventricular diastolicdysfunction.Compared with NLVDD group,subjects in LVDD group were older(61.1±11.6vs55.2±11.3,P<0.001),the proportion of hypertensions(79.4%vs 47.8%,P<0.05)and women(45.6%vs37.9%,P<0.05)were higher,RI was lower(4.55±0.71vs4.89±0.78,P<0.001),The logistic regression analysis showed that:hypertension(OR:3.141,95%CI:2.02~4.88,P<0.001),female(OR:1.645,95%CI:1.09~2.46,P<0.05),age(OR:1.033,95%CI:1.015~1.052,P<0.001),RI(OR:0.719,95%CI:0.548~0.944,P<0.05)were associated with left ventricular diastolic dysfunction.2.347 hypertensives were enrolled in this study including 143 with left ventriculardiastolic dysfunction and 204 without left ventricular diastolic dysfunction.Compared with NLVDD group,subjects in LVDD group were older(60.76±12.28vs57.16±12.18,P<0.05),the proportion of smoking(32.1%vs28.9%,P<0.05)and women(46.2%vs28.9%,P<0.05)were higher,while the RI in LVDDgroup was lower(4.47±0.72vs4.68±0.68,P<0.05).The logistic regression analysisshowed that:smoking history(OR:2.038,95%CI:1.098~3.781,P<0.05),female(OR:1.695,95%CI:1.001~3.081,P<0.05),age(OR:1.020,95%CI:1.001~1.041,P<0.05),andRI(OR:0.573,95%CI:0.396~0.828,P<0.05)were associated with left ventriculardiastolic dysfunction.3.Of 347 hypertensive subjects,222 were males(including 77 subjects with LVDD),125 were females(including 66 subjects with LVDD).Gender stratification analysisshowed that,RI in LVDD group was lower than that in controlled group in bothgender(P<0.05).The logistic regression analysis showed RI was associated withwith left ventricular diastolic dysfunction in both males and females.4.347 hypertensive subjects was stratified at the age point of 50 and 65 years old,It'sfound that,in EH patients from 50 to 64 years old,RI in LVDD group wassignificantly lower than that in NLVDD group(P<0.001),The logistic regressionanalysis also discovered that RI was associated with left ventricular diastolicdysfunction.The correlations were not significant when EH patients were less than50 years old,or not less than 65 years old.5.In the Spearman rank correlation,there was significant positive correlation betweenRI and septal e',lateral e',average e',E/A ratio(P<0.05)in totally 347hypertensives,However,negative correlation between RI and mitral E/e',mitral Awave velocity(P<0.05)had been found,there was no relationship between RI andLVEF and FS(P>0.05).Conclusions:1.RI is significantly associated with left ventricular diastolic dysfunction,especially inhypertensives from 50 to 64 years old,the lower of RI,the more possible forEssential Hypertensives patients to develop left ventricular diastolic dysfunction.2.Age,hypertension,female and remodeling index are associated with left ventriculardiastolic dysfunction.