Systemic Hypertension
Two- and Three-Dimensional Speckle Tracking Analysis of the Relation Between Myocardial Deformation and Functional Capacity in Patients With Systemic Hypertension

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The purpose of this study was to investigate left ventricular (LV) mechanics in hypertensive patients by 2- and 3-dimensional (3D) speckle tracking imaging, and determine the relation between the LV mechanics and functional capacity in this population. This cross-sectional study included 51 recently diagnosed, untreated, hypertensive patients, 49 treated subjects with well-controlled arterial hypertension, 52 treated participants with uncontrolled hypertension, and 50 controls adjusted by gender and age. All the subjects underwent 24-hour blood pressure monitoring, complete 2-dimensional and 3D examination, and cardiopulmonary exercise testing. 3D global longitudinal, circumferential, radial, and area strains were similar between the control group and well-controlled hypertensive patients but significantly decreased in comparison with patients with untreated or inadequately controlled hypertension. Similar findings were obtained for LV torsion and twist rate, whereas LV untwisting rate significantly deteriorated from the controls, across the well-controlled group, to the patients with untreated or uncontrolled hypertension. Peak oxygen uptake was significantly lower in the patients with untreated and uncontrolled hypertension than in the controls and the well-treated hypertensive patients. Peak oxygen uptake was independently associated with LV untwisting rate (β = 0.28, p = 0.03), 3D LV ejection fraction (β = 0.31, p = 0.024), and 3D global longitudinal strain (β = 0.26, p = 0.037) in the whole hypertensive population in our study. In conclusion, LV mechanics and functional capacity are significantly impaired in the patients with uncontrolled and untreated hypertension in comparison with the controls and the well-controlled hypertensive patients. Functional capacity is independently associated with 3D global longitudinal strain, LV untwisting rate, and 3D LV ejection fraction.

Section snippets

Methods

Our cross-sectional study included 101 consecutive untreated subjects who were referred to our outpatient clinic due to hypertension screening, and 101 treated hypertensive patients who were referred to our clinic because of treatment evaluation. The study was conducted at Cardiology Department, University Hospital “Dr Dragisa Misovic” in Belgrade, Serbia from October 2011 to March 2013. All the participants underwent 24-hour blood pressure (BP) monitoring, and according to 24-hour systolic BP

Results

Demographic and clinical parameters of the study population are presented in Table 1. The participants were of similar age and gender distribution. The prevalence of different antihypertensive drug groups was similar between the well-controlled and uncontrolled groups.

All participants had similar LV diameters, whereas LV relative wall thickness, left atrial diameter, 2D LV mass index, and E/e′ ratio progressively and significantly increased from the control group, across the well-controlled and

Discussion

The present study explored LV mechanics, assessed by 2D and 3D speckle tracking imaging, and functional capacity in the hypertensive population: the recently diagnosed untreated hypertensive patients and the treated hypertensive patients with well-controlled arterial hypertension and with uncontrolled hypertension; and compared with the normotensive controls. Our results revealed several interesting findings: (1) 2D assessment of LV mechanics showed that only longitudinal and, partly,

Disclosures

The authors have no conflicts of interest to disclose.

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    Drs. Celic and Tadic contributed equally to this work.

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