P320Role of post-systolic shortening of left ventricle for heart failure with preserved ejection fraction in untreated hypertension

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Purpose: Decreased global longitudinal strain (GLS) of left ventricle (LV) was noted in heart failure with preserved ejection fraction (HFpEF). This study investigated the contribution of both GLS and post-systolic shortening of LV to HFpEF in untreated hypertension.Methods: This study recruited 63 patients (mean age 57 ± 12 years, 34 men) with untreated hypertension with normal LV ejection fraction. All patients did not have overt vascular diseases, valvular heart diseases, renal diseases, and other coronary risk factors. HFpEF was diagnosed based on typical symptoms of heart failure without other known causes. Two-dimensional speckle tracking echocardiography with automated function imaging was used for measurement of GLS and post-systolic strain index (PSI). PSI was calculated as [(post-systolic peak longitudinal strain – end-systolic strain)/end-systolic strain] × 100%. Mitral early filling velocity to average mitral annulus early velocity ratio (E/e') was used as an index for LV filling pressure.Results: HFpEF was diagnosed in 17 patients (27%). Patients with HFpEF had lower early mitral velocity, lower mitral early to atrial velocity ratio, and longer isovolumic relaxation time. There were no differences in biplane LV ejection fraction, blood pressure, heart rate and body weight. GLS was significantly lower (-16.1 ± 3.1 vs. -19.1 ± 3.1 %, p = 0.001), and PSI (303 ± 249 vs. 84 ± 51 %, p <0.001), left ventricular mass index (110 ± 38 vs. 87 ± 22 gm/m2, p = 0.006), E/e' (12.2 ± 3.5 vs. 8.5 ± 1.8, p <0.001) were significantly higher in patients with HFpEF. Multivariable analysis showed GLS (OR 1.695, 95%CI 1.055-2.723, p = 0.029), PSI (every 10% increment OR 1.159, 95%CI 1.029-1.304, p = 0.015), and E/e' (OR 1.798, 95% CI 1.053-3.071, p = 0.032) were independent factors for HFpEF. Area under receiver-operating characteristics curve for diagnosis of HFpEF was 0.888 for PSI, 0.814 for E/e', and 0.757 for GLS.Conclusions: Both systolic strain and post-systolic shortening were contributed to HFpEF. PSI had significant effect on HFpEF in untreated hypertension.

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