Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction

Abstract

Background Early detection of risk factors for left ventricular (LV) dysfunction may be useful in patients with high blood pressure (HBP). Methods Patient from an outpatient HBP clinic underwent a two-dimensional Doppler-coupled echocardiography with determination of LV global longitudinal strain (GLS) by speckle-tracking. Results Among 200 patients (mean age 61.7 ± 9.7 years), 155 were overweight, 93 had diabetes, 83 had dyslipidemia, and 109 had uncontrolled HBP. LV hypertrophy (LVH) was found in 136 patients (68%), including concentric ( n = 106) and eccentric ( n = 30) LVH. Diastolic dysfunction patterns were observed in 178 patients (89%), and increased filling pressures were observed in 37 patients (18.5%). GLS ranged from -25% to -11.6% (mean -16.9 ± 3.2%). Low GLS values (>-17%) were found in 91 patients (45.5%), 68 with and 23 without LVH. In univariate analysis, a reduced GLS was associated with HBP lasting for >10 years (odds ratio (OR) = 3.51, 95% confidence interval (CI) 1.73-7.09; p = 0.002), uncontrolled HBP (OR = 3.55, 95% CI 1.96-6.43; p < 0.0001), overweight (OR = 2.01, 95% CI 0.93-4.31; p = 0.0028), diabetes (OR = 2.21, 95% CI 1.25-3.90; p = 0.006), dyslipidemia (OR = 2.16, 95% CI 1.22-3.84; p = 0.008), renal failure (OR = 4.27, 95% CI 1.80-10.10; p = 0.001), an increased Cornell index (OR = 3.70, 95% CI 1.98-6.90; p < 0.0001), concentric LVH (OR = 9.26, 95% CI 2.62-32.73; p = 0.001), remodeling (OR = 8.51, 95% CI 2.18-33.23; p = 0.002), and filling pressures (OR = 7.1, 95% CI 2.9-17.3; p < 0.0001). In multivariable analysis, duration of HBP ( p = 0.038), uncontrolled BP ( p = 0.006), diabetes ( p = 0.023), LVH ( p = 0.001), and increased filling pressures ( p = 0.003) remained associated with GLS decline. Conclusion Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH.

Assessment of Left Ventricular Torsion in Hypertensive Patients

“…Sofi Taleb et al studied longitudinal LV global strain in 200 hypertensive patients, and found that it was reduced in hypertensive patients (<−17%). In univariate analysis, a reduced global longitudinal strain of LV was associated with HTN duration > 10 years (P value < 0.005) also, reduced in uncontrolled HTN (P value < 0.0001) [28].…”

“…The global longitudinal strain of the LV is one of the parameters that assess systolic function and detects its early impairment before affection of ejection fraction [27]. Other studies with larger sample volume demonstrated a significant reduction in global LV longitudinal strain in hypertensive group than control group [28]. Sofi Taleb et al studied longitudinal LV global strain in 200 hypertensive patients, and found that it was reduced in hypertensive patients (<−17%).…”

The Value of Speckle Tracking Strain Imaging at Recovery Period of Dobutamine Stress Echocardiography

“…The remaining 6 patients were terminated because of ischemic signs. Patient classified into two groups based on the coronary angiography results, group 1: Coronary artery disease positive (CAD +ve) including 25 patients (47.2%) and group 2: Coronary artery disease negative (CAD -ve) including 28 patients (52.8%).There was no significant difference as regards demographic data and risk factors between two groups(Table 1) and this actually was planned from the start to eliminate the possible effects of diabetes mellitus and hypertension on myocardial deformation proved by other studies[18] [19].…”

Editor’s Presentation Benefit of healthy lifestyle on cardiovascular risk factor control: Focus on body weight, exercise and sleep quality

“…In this respect, a refinement in the evaluation of LV systolic function could be achieved by using global longitudinal strain, overcoming some limitations linked to LVEF measurements such as geometric assumptions and technical issues, such as apical foreshortening and difficulties in proper delineation of endocardial borders. 14,15 REACH-HF: cost-effectiveness of home-based cardiac rehabilitation in heart failure REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure) is a home-based cardiac rehabilitation programme delivered over 12 weeks by a trained healthcare professional, co-developed with patients, caregivers and clinicians to include core components of comprehensive cardiac rehabilitation (i.e. education, psychological support and exercise training).…”