Effect of dipping and nondipping pattern of blood pressure on subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking in hypertensive patients

Abstract

The aim of this study was to evaluate the left ventricular (LV) function by conventional two-dimensional speckle tracking echocardiography (2D STE) to detect subclinical LV systolic dysfunction in patients with dipper and nondipper hypertension.Methods One hundred consecutive patients with hypertension were included in our study. Clinical evaluation, baseline laboratory investigations, 24 ambulatory blood pressure monitoring 2D echocardiographic examination and 2D STE were performed for all patients. Patients were classified as dippers and nondippers according to their nighttime MAP (mean arterial blood pressure) reduction rate of ≥10 or <10%, respectively. ResultsOf 100 patients, 71% were nondippers while 29% were dippers. Nondippers had a significantly lower global longitudinal strain (LS) value (−22.45 ± 3.26 vs. −18.2 ± 3.3, P < 0.001), global circumferential strain (CS) value (−24.23 ± 3.56 vs. −19.16 ± 8.25, P < 0.001) and global radial strain (RS) value (35.04 ± 11.16 vs. 29.58 ± 8.44, P = 0.009). It was found that nondipper status was associated with worsening of LS by 2.737, (P = 0.001), CS by 3.446, (P = 0.002), RS by −3.256, (P = 0.158) and DM also was found associated with worsening of LS by 1.849, (P = 0.062), CS by 3.284 (P = 0.018), RS by −2.499 (P = 0.381). ConclusionThe nondipping hypertension pattern is associated with subclinical LV systolic dysfunction as shown by the impaired global myocardial strain in all three directions.

Early Left Ventricular Dysfunction and Non-Dipping: When Ejection Fraction is Not Enough. A Meta-Analysis of Speckle tracking Echocardiography Studies

“…The majority of studies investigating LV remodelling in patients with different circadian BP patterns reported a significant deterioration in LV structure and diastolic function in non-dippers in comparison with dippers (21,22,26,28,29). This may be related to the association between nocturnal hypertension in non-dippers and LV remodelling induced by overactivated sympathetic nervous system, renin-angiotensin-aldosterone system, sleep apnoea syndrome.…”

“…Mechanical LV changes recently implemented in clinical studies may reveal subclinical and subtle impairments in LV function previously undetectable with conventional echocardiographic assessment. Although differences were noticed for longitudinal, circumferential and radial strains (25,26,28), major attention has been paid to GLS, which represents not only a robust echocardiographic parameter that reveals subtle impairment of LV function, but also a paramount predictor of adverse outcomes, including mortality. GLS turned out to be a more sensitive and reproducible parameter than conventional LVEF in general (34) and hypertensive population (19).…”