Usefulness of Speckle Tracking Echocardiography in Hypertensive Crisis and the Effect of Medical Treatment

Alam, Mahboob; Zhang, Lily; Stampehl, Mark R.; Lakkis, Nasser; Dokainish, Hisham

doi:10.1016/j.amjcard.2013.03.025

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…Furthermore, Andersen et al found there was not a strong correlation between changes in E/E' and changes in LV filling pressure (17). Conversely, the global LV diastolic SR collected using 2DSTE may overcome all the aforementioned limitations and provide a more complete reflection of overall LV diastolic function than E/E' (9,10,(15)(16)(17). Notably, this measurement reflects the total performance of all LV segments.…”

Section: Discussionmentioning

confidence: 99%

“…E/E' has been shown to be useful in predicting elevated LV filling pressures in clinical studies; however, E/E' has a significant gray zone and is less reliable in preserving LVEF >50% due to several factors (9,15). Firstly, there are well-known limitations of Doppler-based methods such as the angle dependency, which has the potential for significant errors with angulations >20˚.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, regional wall motion abnormalities in the sampling region may lead to low annular velocities on tissue Doppler despite near normal LV relaxation. Thirdly, another important limitation of this approach is the potential effect of LA pressure (9,15,16). Since E' occurs during the early phase of LV filling, not only LV relaxation, but also LA pressure has an important impact on its value.…”

Section: Discussionmentioning

confidence: 99%

“…Previous literature suggests that the mechanism underlying the impairment of LV diastolic function in patients with CKD and HP may be due to increased transmyocardial wall stress, which can produce subendocardial ischemia, thus increasing myocardial stiffness and reducing myocardial deformation in diastole. As BP decreases following medical treatment, LV wall stress also decreases, thus decreasing LV stiffness and improving myocardial diastolic function (8,15). Antihypertensive agents reduce endothelial dysfunction and microvascular disease, which has been shown to contribute to a worsening of cardiovascular risk factors and may also play a role in the pathophysiological process that leads to accelerated cardiovascular disease in patients with CKD (8).…”

Section: Discussionmentioning

confidence: 99%

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Antihypertensive treatment improves left ventricular diastolic function in patients with chronic kidney disease

Wang

Dai

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. In patients with chronic kidney disease (CKD), hypertension (HP) is associated with the development of left ventricular (LV) diastolic dysfunction. However, the impact of antihypertensive treatment on LV diastolic function has not been well studied in CKD patients. Recently, two-dimensional speckle-tracking echocardiography (2DSTE) has emerged as a sensitive and quantitative assessment of LV diastolic function. The present study used 2DSTE to investigate the effects of antihypertensive treatment on LV diastolic function in patients with CKD and untreated HP. The study comprised 134 patients with CKD and untreated HP. The patients received blood pressure (BP)-lowering therapy for six months. The patients were clinically and echocardiographically evaluated at baseline and after 6 months of therapy. It was found that the mean systolic BP (SBP) and diastolic BP (DBP) at baseline were 154.0±7.0 and 92.6±10.2 mmHg, respectively, decreasing to 121.2±7.3 and 74.6±10.4 mmHg, respectively (P<0.05 for both) after the 6-month treatment period. Moreover, the mean peak LV strain rate during the isovolumetric relaxation period (SR IVR ) and early diastole (SR E ) improved following treatment (from 0.23±0.10 to 0.42±0.10 sec -1 and from 0.58±0.25 to 1.07±0.24 sec -1 , respectively; P<0.05 for both). Notably, the patients with CKD stage ≥3 were more likely to demonstrate an improvement in diastolic speckle-tracking parameters than those with CKD stage 1 or 2. For the entire population, the change (Δ) in B-type natriuretic peptide (BNP) level correlated with changes in echocardiographic parameters between baseline and follow-up, among which ΔSR IVR presented the highest correlation coefficient (r=-0.73, P<0.01). On multivariate analysis, the independent predictors of ΔSR IVR were found to include baseline CKD stage, SBP and SR IVR . This study demonstrated that LV diastolic function was improved in CKD patients following antihypertensive treatment, particularly in patients with CKD stage ≥3, higher baseline SBP and worse LV diastolic function. These results highlight the importance of BP reduction in the treatment of CKD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Antihypertensive treatment improves left ventricular diastolic function in patients with chronic kidney disease

Wang

Dai

et al. 2015

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

show abstract

“…Even if new echocardiography imaging techniques are not used extensively in daily clinical practice, it seems that speckle-tracking echocardiography may detect depressions of global longitudinal left ventricular systolic strain and global systolic strain rate during hypertensive crisis as opposed to left ventricular ejection fraction (13). Despite this interesting finding, speckle tracking echocardiography is not easy to implement in an emergency department setting.…”

Section: Diagnosismentioning

confidence: 99%

Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature

Varounis

Katsi

Nihoyannopoulos³

et al. 2017

Front. Cardiovasc. Med.

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Despite the high prevalence of hypertension (HTN), only a small proportion of the hypertensive patients will ultimately develop hypertensive crisis. In fact, some patients with hypertensive crisis do not report a history of HTN or previous use of antihypertensive medication. The majority of the patients with hypertensive crisis often report non-specific symptoms, whereas heart-related symptoms (dyspnea, chest pain, arrhythmias, and syncope) are less common. Hypertensive crises can be divided into hypertensive emergencies or hypertensive urgencies according to the presence or absence of acute target organ damage, respectively. This differentiation is an extremely useful classification in clinical practice since a different management is needed, which in turn has a significant effect on the morbidity and mortality of these patients. Therefore, it is very crucial for the physician in the emergency department to identify the hypertensive emergencies and to manage them through blood pressure lowering medications in order to avoid further target organ damage or deterioration. The aim of this narrative review is to summarize the recent evidence in an effort to improve the awareness, recognition, risk stratification, and treatment of hypertensive crisis in patients referred to the emergency department.

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Cardiovascular Hypertensive Emergencies

et al. 2015

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Inevitably, a small proportion of patients with systematic hypertension will develop hypertensive crisis at some point. Hypertensive crises can be divided into hypertensive emergency or hypertensive urgency according to the presence or lack of acute target organ damage. In this review, we discuss cardiovascular hypertensive emergencies, including acute coronary syndrome, aortic dissection, congestive heart failure, and sympathomimetic hypertensive crises, including those caused by cocaine use. Each presents in a unique fashion, although some hypertensive emergency patients report nonspecific symptoms. Treatment includes several effective and rapid-acting medications to safely reduce the blood pressure, protect remaining end-organ function, relieve symptoms, minimize the risk of complications, and thereby improve patient outcomes.

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Usefulness of Speckle Tracking Echocardiography in Hypertensive Crisis and the Effect of Medical Treatment

Cited by 9 publications

References 24 publications

Antihypertensive treatment improves left ventricular diastolic function in patients with chronic kidney disease

Antihypertensive treatment improves left ventricular diastolic function in patients with chronic kidney disease

Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature

Cardiovascular Hypertensive Emergencies

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