Apical Morphological And Dynamic Features Of Left Ventricular In Patients With Hypertension

ObjectivesThe specificity of the apical myocardial structure makes it an important position in the left ventricular systolic function.The changes in myocardial structure and dynamics of the apex are predictors of disease progression.This study observed left ventricular apical morphological and dynamic parameters such as the apical vertical angle and rate of change during systole,apical ejection velocity in hypertension patients with different left ventricular geometry using echocardiography to understand the changes in left ventricular apex of hypertension patients in different configuration.Methods101 patients with primary hypertension?HT?who were admitted to the outpatient clinic of the First Affiliated Hospital of Fujian Medical University from April 2018 to October 2018,76 male,average age59.2±11.2?range 29 to 80 years old?,except patients with coronary heart disease,pulmonary heart disease,severe valvular heart disease,etc.And 38 age and gender matched volunteers were selected as the control group?NC group?,28 male,average age56.6±9.7?range 32 to 79 years old?.According to Ganau classification with left ventricular mass index?LVMI?and relative wall thickness?RWT?,HT patients were divided into four groups:Normal contral group?NG group,32 cases?,Concentric remodeling group?CR group,31cases?,Concentric hypertrophy group?CH group,17 cases?,and Eccentric hypertension group?EH group,21 cases?.The selected patients underwent transthoracic echocardiography and synchronous electrocardiogram.Echocardiographic parameters were acquired included:1.Conventional echocardiographic parameters:left ventricular end-diastolic and end-systolic diameter?LVDd,LVDs?,interventricular septal thickness and left ventricular posterior wall thickness?IVST,LVPWT?,left ventricular ejection fraction using Simpson's method in standard four-chamber view?LVEF?,transmitral diastolic inflow velocity?E,A?,average peak systolic velocities of mitral annulus,average early diastolic velocities of mitral annulus and average late diastolic velocities of mitral annulus?Sa,e,a?,calculation E/e;2.Apical hemodynamic parameters:apical ejection velocity(V_ap)and its ratio to the left ventricular outflow tract ejection velocity(V_LVOT)(V_ap/V_LVOT);3.Apical morphological parameters:the apical end-diastolic vertical angle and the apical end-systolic vertical angle(?_ap-d,?_ap-s)and fractional angle change(??_ap=(?_ap-d-?_ap-s)/?_ap-d);4.Apical fractional shortening(FS_ap).Results1.Left ventricular geometry and global systolic function:With the development ofleft ventricular geometry of hypertension,the left ventricular diameter and end-diastolic volume index?LVEDVI?were smaller in the CR group than in the NG group?P<0.05?,while the CH group and EH group were enlarged compared with the CR group.LVEF?Simpson's method?in NG group was higher,and in EH group were significantly lower?all P<0.05?.Longitudinal contraction function parameter?Sa?decreased in all the hypertension groups,especially in EH group?all P<0.05?.2.left ventricular apical morphological and dynamic parameters:from NG to EH group,apical vertex angle??ap?showed a first decrease and then expanded.Among them,the apical end-diastolic vertical angle was the smallest in the CH group and the EH group was the largest(?_ap-dp-d NG:94.1±8.2°,CR:80.5±6.9°,CH:78.5±6.6°,EH:90.5±11.6°).The left ventricular configuration progressed,the LV apical dynamics parameter such as apical ejection velocity(V_app NG:0.26±0.05m/s,CR:0.36±0.15 m/s,CH:.29±0.06 m/s,EH:0.27±0.08 m/s)and fractional angle change(??_app NG:24.5±10.1%,CR:30.6±10.4%,CH:26.7±10.1%,EH:15.8±10.4%)showed a first increase and then a decrease trend,largest in the concentric remodeling group and the smallest in the eccentric hypertension group.3.Correlation analysis:In the CH,EH group,?_ap-s was moderately correlated withLVMI?r values were 0.49 and 0.60,all P<0.05?,but not in the NG group and CR group.In the HT group,FS_ap and??_ap was moderately correlated with LVEF?r values were 0.53 and 0.48,all P<0.05?,but in NC group LVEF was not associated with it.ConclusionsWhen the overall systolic function of hypertensive patients is normal or enhanced,the mechanical properties of myocardial local contractions have changed,manifested in apical myocardial remodeling and apical dynamics.