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Systemic hypertension (HTN) leads to LV remodeling, resulting in diastolic dysfunction in the presence of preserved systolic function. Speckle tracking echocardiography (STE) may detect changes in left ventricular systolic function, not apparent with use of ejection fraction (EF) alone. In the present study, we utilized STE to determine predictors of abnormal longitudinal strain in a cohort of ambulatory HTN patients with preserved LV EF (PEF) and no history of heart failure.
HTN patients with PEF underwent routine echocardiograms with off-line longitudinal strain analysis in an outpatient clinic from 8/2011-8/2012. Patients with ischemic, dilated, or hypertrophic cardiomyopathies, primary pulmonary disease and/or systemic disease associated with secondary pulmonary disease, end-stage renal disease, hemodynamically significant valvular disease, and wall motion abnormalties were excluded.
The cohort included 138 patients (61% female); age 61±13 years with mean BP 145±25/81±11 mmHg, and BMI 30±6 g/m2. The average EF was 71.5±9.5%, with LV mass of 148.6±49.1 grams and 215.25 ± 90.1 when indexed for BSA, and 88.3±27.6 when indexed for height. The mean peak longitudinal systolic strain was −17.8±4.1% (lower limit of normal −18.5%). In bivariate regression analysis, increased LV mass and mass indices, were associated with decreasing longitudinal systolic strain (r=0.32 p<0.0001, r=0.27 p<0.002, and r=0.30 p<0.0004 respectively). In multiple regression analysis, with adjustment for age, gender, and BMI, LV mass emerged as the strongest correlate of peak longitudinal strain (p<0.001).
In these asymptomatic patients with PEF and Stage 1 and 2 HTN, we found abnormalities of longitudinal systolic strain using STE, despite apparently normal systolic function. Increasing LV mass was the strongest predictor for abnormal strain, and was independent of age or body size. The identification of impaired longitudinal systolic strain in systemic HTN with PEF may have important implications for more aggressive BP control in certain patients, and ultimately, the prevention of heart failure.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: LV Systolic Function
Abstract Category: 18. Imaging: Echo
Presentation Number: 1142-349
- 2013 American College of Cardiology Foundation