P376Myocardial deformation in hypertensive heart disease: speckle tracking echocardiographic study

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Background: many patients with heart failure have antecedent hypertension and identifying subclinical LV dysfunction may help in identifying patients at a higher risk for heart failure.Aim of study to identify subclinical abnormality in left ventricular function among hypertensive patients with or with out left ventricular hypertrophy using speckle tracking imaging.Methods: The current study enrolled 108 hypertensive patients and 40 healthy controls underwent standard 2D echocardiography ,tissue Doppler imaging (TDI) , 2D speckle tracking echocardiography . TDI-derived velocities of mitral annulus, peak systolic velocity during ejection period (S) & early(É) and late(Á) diastolic velocities were obtained and averaged in four mitral annuli. Peak longitudinal strain was calculated and averaged in apical long axis, four and two chamber views( global longitudinal straine).Results: Blood pressure and LV mass index were higher in patients with hypertension than controls without significant difference in ejection fraction. Mitral annular Systolic (S) velocities were relatively higher in controls than patients but did not attain statistical significance (10±2 ,9±7cm/s respectively). Early diastolic velocity (É) were lower (P < .0001) and the E/ É ratio was higher (P < .001) in patients with hypertension. In separate analysis of the patients by tertiles of LV mass, significantly lower longitudinal strain(ε) was observed in patients with increased LV mass (ε= −16±4%) compared to patients with normal LV mass (ε= −19±3%) or compared to controls (ε= -20±6%) (p<0.001 for all). Relative wall thickness is negatively correlated to É (r= −0.37, p<0.001)and positively correlated to E/É (r = 0.24&p< 0.05). Longitudinal strain is negatively correlated to both LV mass (r=−0.55&p<0.001) and relative wall thickness (r=−0.33&p<0.01).Conclusion: Global longitudinal strain is reduced in hypertensive patient and reduced more with extreme LV hypertrophy. The extent of global longitudinal strain is strongly associated with LV diastolic function.

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