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Background: Abnormal left ventricular (LV) global systolic strain (GLS) using speckle tracking imaging may be reduced in hypertensive heart disease. Limited data exists on the impact that severe blood pressure (BP) elevation, and subsequent improvement, have on LV GLS. We hypothesized that in hospitalized patients presenting with uncontrolled hypertension (HTN), LV GLS may improve promptly after treatment.
Methods: We prospectively enrolled 82 hospitalized patients with uncontrolled HTN (BP >160 mmHg) and normal LV ejection fraction on echocardiogram. A second echo was performed prior to discharge in patients with > 10% reduction in BP. Peak LV GLS was measured off-line using Philips Q-lab data analysis workstation.
Results: The 82 patients (50 females) were mean age 61.2 ± 14.6 years and had LV GLS −18 ± 3.93 % (range 9.4 – 27.8 %). Significant relationships (p < 0.05) were found between LV GLS and LV wall thickness (r = −0.47), renal function (r = 0.22), and body weight (r = −0.36). Of the 82 HTN patients, 38 (46%) with improved BP had a 2nd echo on average 2 days later, prior to discharge. Of these 38 patients, 10 (26%) demonstrated ≥10% increase in LV GLS with improved BP. The remaining 28 (74%) had < 10% increase LV GLS. Blood pressure did not differ among patients with or without increased LV GLS; LV mass was also similar. However, patients with increased LV GLS were younger (52.5 ± 17.5 vs. 62.6 ± 15.1 years, p < 0.02) and had better baseline right ventricle function (fractional area change 44.3 ± 9.14 vs. 34.7 ± 6.3 %, p < 0.03).
Conclusions: Among patients hospitalized with severe hypertension and normal LV ejection fraction, LV global longitudinal strain varies considerably and is related to LV mass, renal function and body weight. A substantial minority of patients (26%) showed prompt improvement in LV strain after BP decline. These patients were younger and had better baseline RV function. These findings demonstrate that abnormalities of LV systolic strain may quickly improve after treatment of hypertension. This effect does not appear to be solely a consequence of changes in afterload, since the majority of patients showed persistent abnormalities despite similar blood pressure reduction.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Innovative Use of Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1197-225
- 2017 American College of Cardiology Foundation