Prognostic implications of longitudinal strain in hypertensive patients

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Tlemcen Introduction Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular (LV) pressure overload, and, in turn, changes in cardiac geometry and LV hypertrophy (LVH). 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. This decline in longitudinal function may be a determining factor in the occurrence of cardiovascular complications and therefore an increase in cardiovascular morbidity and mortality. Purpose : This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events in hypertensive patients. Methods We retrospectively studied 400 asymptomatic patients with hypertension of which, 182 patients had abnormal global longitudinal strain(GLS) and 218 patients had normal GLS, between 2016 and 2019. Global longitudinal strain (GLS) was measured using speckle tracking. Patients were followed for admission because of heart failure, myocardial infarction, atrial fibrillation and strokes, over median of 4 years. At the start of study, all patients had preserved LV ejection fraction. Résultats : The control of patients noted 25 cases (6.25%) of attacks of heart failure in the arm hypertension with low GLS against only 4 cases (1%) in the arm hypertension + normal GLS (P <0.001). The same, 19 ( 4.75%) hypertensive patients with low GLS had a stroke compared to only 5 (1.25%) hypertensive patients with normal GLS. A significant difference in the incidence of onset of acute coronary syndromes was also noted in the hypertension arm with abnormal GLS (P = 0.002). As for rhythmic complications, 26 (6.5%) hypertensive patients with abnormal GLS developed atrial fibrillation compared to only 9 (2.25%) hypertensive patients with normal GLS (P <0.0001). Conclusion : GLS and its deterioration are associated with cardiovascular complications in asymptomatic hypertensive heart disease. Although LVEF will remain a cornerstone of LV function assessment, the addition of GLS enables detailed phenotyping and improved risk assessment and is a tool for present and future therapeutic advancement. A risk score incorporating strain was useful for predicting risk of cardiac events.

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Prognostic utility of routine assessment of left ventricular global longitudinal strain and peak atrial reservoir strain in stable heart disease patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.0107 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.I Bolog ◽

M Dumitrescu ◽

E Pacuraru ◽

F Romanoschi ◽

A Rapa

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Acute Coronary Syndromes ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Events ◽

Coronary Syndromes ◽

Routine Assessment

Abstract Background Left ventricular ejection fraction above 40% is a poor predictor of cardiac outcomes. Strain imaging seems to add incremental prognostic value in various heart conditions. Purpose The aim of the study is to investigate whether assessment of both left ventricular global longitudinal strain (LVGLS) and peak atrial reservoir strain (PARS) in routine daily practice is useful in predicting cardiac events. Methods We prospectively enrolled 300 patients (212 men, mean age 64.8±10.9 years old) with stable cardiac disease, referred for echocardiographic examination and eligible for strain imaging. Conventional and speckle tracking 2D rest echocardiography were performed and clinical variables were recorded. We excluded patients with acute coronary syndromes, severe valvular disease, cardiomyopathies, arrhythmia and class IV NYHA. Results During a median follow up of 30 months, there were 111 cardiac events (CE) recorded including: 7 cardiac deaths (CD), 25 acute coronary syndromes (ACS), 45 hospitalisations for worsening heart failure (WHF), 23 episodes of atrial fibrillation (AF), 11 stroke (S). Average EF, LVGLS and PARS in patients with CE were significantly lower than in patients without CE (55.8±8.4%, −17.3±3.9% and 16.3±9.8% vs. 60.4±8.4%, −20.1±3.7% and 28.4±8.2%; p<0.05, p<0.01, p<0.01). In univariate analysis, lower LVGLS, respectively lower PARS were associated with a higher risk of cardiac events [Hazard Ratio (HR)1.26; 95% CI (confidence interval): 1.08–1.34; p<0.01 per 1% decrease, respectively HR 1.38; 95% CI: 1.16–1.42; p<0.01 per 1% decrease]. On multivariate analysis this association was independent after adjustment for age, gender, hypertension, diabetes, ejection fraction, left atrial indexed volume. Lower LVGLS was a better predictor of a composite of ACS and CD (HR 1.38 per 1% decrease 95% CI: 1.16–1.48; p<0.01). Lower PARS had a stronger association with AF, S and WHF (HR 1.49 per 1% decrease 95% CI: 1.19–1.58; p<0.01). In a model defined by depressed LVGLS (more positive than −18%) adding lower PALS, with a cut off point of 20%, significantly improved prediction of CE (C-statistic increased from 0.68 to 0.83, p<0.001). Conclusions Left ventricular global longitudinal strain and peak atrial reservoir strain are independent predictors of cardiac events patients with stable heart disease. Acute coronary syndromes and death were better predicted by depressed LVGLS and onset of atrial fibrillation, stroke and worsening heart failure were better predicted by lower PARS. Routine assessment of both parameters improves significantly prediction of cardiac events and helps clinical decision making. Funding Acknowledgement Type of funding source: None

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Myocardial work in Stage 1 and 2 hypertensive patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab043 ◽

2021 ◽

Author(s):

Akshar Jaglan ◽

Sarah Roemer ◽

Ana Cristina Perez Moreno ◽

Bijoy K Khandheria

Keyword(s):

Ejection Fraction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Hypertensive Patients ◽

Non Invasive ◽

Significant Difference ◽

Lv Ejection Fraction ◽

Global Work ◽

Stage 1

Abstract Aims Myocardial work (MW) is a novel parameter that can be used in a clinical setting to assess left ventricular (LV) pressures and deformation. We sought to distinguish patterns of global MW index in hypertensive vs. non-hypertensive patients and to look at differences between categories of hypertension. Methods and results Sixty-five hypertensive patients (mean age 65 ± 13 years; 30 male) and 15 controls (mean age 38 ± 12 years; 7 male) underwent transthoracic echocardiography at rest. Hypertensive patients were subdivided into Stage 1 (n = 32) and Stage 2 (n = 33) hypertension based on 2017 American College of Cardiology guidelines. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, reduced ejection fraction, valvular heart disease, intracardiac shunt, and arrhythmia. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency were estimated from LV pressure–strain loops utilizing proprietary software from speckle-tracking echocardiography. LV systolic and diastolic pressures were estimated using non-invasive brachial artery cuff pressure. Global longitudinal strain and LV ejection fraction were preserved between the groups with no statistically significant difference, whereas there was a statically significant difference between the control and two hypertension groups in GWI (P = 0.01), GCW (P < 0.001), and GWW (P < 0.001). Conclusion Non-invasive MW analysis allows better understanding of LV response under conditions of increased afterload. MW is an advanced assessment of LV systolic function in hypertension patients, giving a closer look at the relationship between LV pressure and contractility in settings of increased load dependency than LV ejection fraction and global longitudinal strain.

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Application of the current HFA-ESC consensus guidelines on diagnosis of heart failure with preserved ejection fraction to a population referred for echocardiography

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.038 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Liang ◽

R Hearse-Morgan ◽

S Fairbairn ◽

Y Ismail ◽

AK Nightingale

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Diastolic Function ◽

Global Longitudinal Strain ◽

Diagnostic Algorithm ◽

Left Ventricular ◽

Lv Function ◽

Preserved Ejection Fraction ◽

Consensus Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The recent Heart Failure Association (HFA) of the European Society of Cardiology (ESC) consensus guidelines on diagnosis of heart failure with preserved ejection fraction (HFpEF) have developed a simple diagnostic algorithm for clinical use. PURPOSE To assess whether echocardiogram (echo) parameters needed to assess diastolic function are routinely collected in patients referred for assessment of heart failure symptoms. METHODS Retrospective analysis of echo referrals in January 2020 were assessed for parameters of diastolic function as per step 2 of the HF-PEFF diagnostic algorithm. Echo images and clinical reports were reviewed. Electronic records were utilised to obtain clinical history, blood results (NT-proBNP) and demographic data. RESULTS 1330 patients underwent an echo in our department during January 2020. 83 patients were referred with symptoms of heart failure without prior history of cardiac disease; 20 patients found to have impaired left ventricular (LV) function were excluded from analysis. Of the 63 patients with possible HFpEF, HF-PEFF score was low in 18, intermediate in 33 and high in 12. Median age was 68 years (range 32 to 97 years); 25% had a BMI >30. There was a high prevalence of hypertension (52%), diabetes (19%) and atrial fibrillation (40%) (cf. Table 1). Body surface area (BSA) was documented in 65% of echo reports. Most echo parameters were recorded with the exception of global longitudinal strain (GLS) and indexed LV mass (cf. image 1). NT-proBNP was recorded in only 20 patients (31.7%). 12 patients with an intermediate HF-PEFF score could have been re-categorised to a high score depending on GLS and NT-proBNP (which were not recorded). CONCLUSION More than three quarters of echoes acquired in our department obtained the relevant parameters to assess diastolic function. The addition of BSA, and inclusion of NT-proBNP, and GLS would have been additive to a third of ‘intermediate’ patients to determine definite HFpEF. Our study demonstrates that the current HFA-ESC diagnostic algorithm and HF-PEFF scoring system are easy to use, highly relevant and applicable to current clinical practice. Age >70 years 29 (46.0%) Obesity (BMI >30) 16 (25.4%) Diabetes 12 (19%) Hypertension 33 (52.4%) Atrial Fibrillation 25 (39.7%) ECG abnormalities 18 (28.5%) Table 1. Prevalence of Clinical Risk Factors Abstract Figure. Image 1. HFPEFF score & echo parameters

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P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.819 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E Sakaguchi ◽

A Yamada ◽

M Hoshino ◽

K Takada ◽

N Hoshino ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Stable Condition ◽

Left Ventricular ◽

Operating Characteristics ◽

Cardiac Events

Abstract Purposes We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission. Methods We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (> 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events. Results Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p < 0.0001, log-rank). Conclusion A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

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P803 Myocardial work in acutely decompensated heart failure patients differs between HFrEF and HFpEF

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.459 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

F Sahiti ◽

C Morbach ◽

C Henneges ◽

M Hanke ◽

R Ludwig ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Future Research ◽

Lv Function ◽

Acutely Decompensated Heart Failure

Abstract OnBehalf AHF Registry Background & Aim A novel echocardiographic method to non-invasively determine left ventricular (LV) myocardial work (MyW) based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated against invasive reference measurements. MyW is considered less load-dependent than LV ejection fraction (EF) and LV longitudinal strain. We investigated MyW indices in patients with reduced ejection fraction (LVEF <40%; HFrEF) and patients with preserved ejection fraction (LVEF ≥50%, HFpEF) admitted for acutely decompensated heart failure (AHF). Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed on the day of admission. MyW assessment was performed off-line using EchoPAC (GE, version 202). Here we present MyW indices and performed two-sided t-tests to analyze differences in numerical baseline covariates. Results We analyzed the echocardiograms of 94 AHF patients (72 ± 10 years; 36% female). 46 patients (49%) had an LVEF <40%, while 48 patients (51%) presented with LVEF ≥50%. HFrEF patients were younger, less often female, and hat lower blood pressure (table). Consistent with lower LVEF, HFrEF patients had less negative global longitudinal strain and lower global constructive work, when compared to HFpEF patients. Since HFrEF patients also had higher global wasted work, this yielded a lower myocardial work efficiency compared to HFpEF patients (table). Conclusions This analysis in patients with AHF exhibited marked differences in MyW indices according to subgroups with HFrEF and HFpEF, thus adding information to the classical measures of LV function. Future research has to determine whether constructive and/or wasted MyW are valuable diagnostic or therapeutic targets in patients with AHF. Abstract P803 Figure.

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Abstract 11749: Prognostic Value of Left Ventricular Global Longitudinal Strain and Ejection Fraction in Patients With Non-ischemic and Ischemic Heart Disease

Circulation ◽

10.1161/circ.132.suppl_3.11749 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tetsuari Onishi ◽

Yasue Tsukishiro ◽

Hiroya Kawai

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Ejection Fraction ◽

Ischemic Heart Disease ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Ischemic Heart ◽

Lv Function

Background: Both Left ventricular (LV) global longitudinal strain (GLS) and LV ejection fraction (LVEF) are useful parameters for assessment of LV function. The aim of this study is to confirm the prognostic value of them in patients with non-ischemic and ischemic heart disease. Methods: We studied 179 patients (DCM group: Age 61±15 years, 70 females, LVEF 33±9%) with non-ischemic dilated cardiomyopathy and heart failure symptom, and 97 patients (MI group: Age 66±13 years, 18 females, LVEF 45±7%) who were successfully treated with percutaneous coronary intervention for acute anteroseptal myocardial infarction. Echocardiography was used for LV GLS derived from 2D speckle-tracking method and LVEF with modified Simpson’s method. Outcome was assessed according to death and re-hospitalization with heart failure in the follow-up period. Results: 40 patients in DCM group and 10 patients in MI group experienced at least one event. In these 2 groups, significant differences in GLS and LVEF were found between patients with and without cardiac events (p<0.05). Kaplan-Meier analysis showed patients with worse GLS had an unfavorable outcome in both DCM and MI groups (p<0.05), but LVEF did not associated with outcome. Conclusion: LV GLS has the potential to predict the outcome with higher sensitivity than LVEF in patients with heart disease regardless of ischemic etiology.

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611 Mild cognitive impairment is associated with subclinical left ventricular dysfunction as assessed by global longitudinal strain in hypertensive patients

European Heart Journal Supplements ◽

10.1093/eurheartj/suab132.017 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Germano Junior Ferruzzi ◽

Valeria Visco ◽

Francesco Loria ◽

Gennaro Galasso ◽

Guido Iaccarino ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Temporal Orientation ◽

Ventricular Ejection Fraction ◽

Hypertensive Patients ◽

Significant Difference

Abstract Aims Left ventricular global longitudinal strain (GLS) detects subtle systolic abnormalities in various cardiovascular conditions, which represent significant risk factors for cognitive impairment and stroke. Specifically, GLS has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). This study investigated the relationship of GLS with mild cognitive impairment (MCI) in hypertensive patients. Methods and results From February 2020 to October 2021 were enrolled hypertensive patients without atrial fibrillation and/or cerebrovascular and/or neurodegenerative diseases. Complete demographic, clinical characteristics, laboratory analyses, conventional echocardiographic parameters were collected. Finally, MCI was defined by accurate the Quick Mild Cognitive Impairment (QMCI) Screen corrected for age and education. This score explores spatial and temporal orientation, registration, delayed recall, clock design, logical memory, and verbal fluency in a brief time (5 min—score 0–100); a compliance questionnaire (Morisky medication adherence scale); a questionnaire on nutritional status (MNA). 81 hypertensive patients [66 ± 7.27 years; 9 (11%) female] were included in the study. Concerning echocardiographic evaluation, LVEF was 50.47 ± 9.95% and mean GLS was −16.00 ± 3.66. Mean QMCI corrected for age and education was 56.45 ± 9.37, and MCI was detected in 21 patients (26%). When comparing the patients with MCI (QMCItot <49.4) and without MCI (QMCItot >49.4), a statistically significant difference of GLS values was detected (no MCI: −16.52 ± 3.66 vs. MCI: −14.18 ± 3.23; P = 0.032); on the other hand, the two groups did not differ in LVEF (no MCI: 50.58 ± 9.70 vs. MCI: 48.86 ± 11.93; P = 0.864). Furthermore, excluding patients with FE ≥ 45% from the analysis, a statistically significant linear regression was observed between QMCI (corrected for age and education) and the GLS (P = 0.014) (Figure 1). Conclusions Compromised GLS, but not LV EF, is related to MCI in hypertensive patients who are free of clinical dementia, stroke, and neurodegenerative disease. Moreover, our study demonstrates for the first time the existence of a significant association between the QMCI and GLS; consequently, GLS could be an additional parameter in clinical practice for early recognition of MCI. However, studies on a larger population will be needed to confirm this association.

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Abstract 20577: Combination of Global Longitudinal Strain and Sympathetic Nervous Dysfunction Predicts Cardiac Events in Patients With Non-Ischemic Dilated Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.20577 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Misato Chimura ◽

Tetsuari Onishi ◽

Hiroya Kawai ◽

Shinishiro Yamada ◽

Yoshinori Yasaka

Keyword(s):

Heart Failure ◽

Regression Analysis ◽

Dilated Cardiomyopathy ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Nervous Activity ◽

Left Ventricular ◽

Sympathetic Nervous Activity ◽

Cardiac Events ◽

Sympathetic Nervous

Introduction: It has been reported that sympathetic nervous dysfunction by 123I-metaiodobenzylguanidine (MIBG) is associated with worse outcome in dilated cardiomyopathy (DCM) patients. However, the association between sympathetic nervous function and myocardial strain is not established. Hypothesis: Global longitudinal strain (GLS) by two-dimensional speckle-tracking echocardiography (2DSTE) is correlated with sympathetic nervous activity, and stratifies DCM patients at risk for cardiac events with a combination of sympathetic nervous activity. Methods: We studied 71 patients who had admitted to a cardiology department with heart failure at the initial visit (age 61±13 years, 45 males, LV ejection fraction (EF) 30±8 %). All patients underwent MIBG imaging for the delayed heart to mediastinum ratio (H/M), and echocardiography with conventional assessment including left atrial volume (LAV), LV end-diastolic and end-systolic volume (LVEDV, LVESV), LVEF, mitral regurgitation grade (MR), early transmitral flow to atrial contraction (E/A) and with 2DSTE analysis for GLS expressed with an absolute value. Cardiac events were assessed according to death and hospitalization with heart failure. Results: There were 21 cardiac events in the follow-up period for 4.9±2.3 years. Univariate regression analysis showed LAV, LVEDV, LVESV, LVEF, MR, E/A and GLS had a significant correlation with delayed H/M (all p < 0.05). Multivariate regression analysis revealed that GLS was an independent predictor of delayed H/M. Dividing all patients into 4 groups by the median of GLS in patients with delayed H/M >1.6 or≤1.6, the combination of the worse delayed H/M and the worse GLS was significantly associated with cardiac events (p=0.03). Conclusions: Left ventricular GLS is significantly correlated with delayed H/M and can be useful to stratify the risk in DCM patients with a combination of delayed H/M.

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P1353 Left ventricular performance patterns in patients with dilated cardiomyopathy and advanced heart failure

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.788 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E Kinova ◽

D Somleva ◽

N Spasova ◽

A Borizanova ◽

A Goudev

Keyword(s):

Heart Failure ◽

Longitudinal Strain ◽

Circumferential Strain ◽

Global Longitudinal Strain ◽

Mitral Annulus ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Volume Index ◽

Lv Function ◽

Performance Patterns

Abstract Background Left ventricular (LV) global longitudinal strain (GLS) is a more sensitive parameter than ejection fraction in the assessment of LV function. It has been established as a predictor of cardiac death and adverse events. In patients with dilated cardiomyopathy (DCM) LV deformation and twist mechanics are reduced in varying degrees. Purpose The aim of the study was to determine different LV performance patterns in patients with DCM and advanced heart failure (HF). Methods In 52 patients with DCM with HF NYHA class III-IV (62 ± 13 years, 36 males) LV function had been assessed by conventional, Tissue Doppler and 2D-speckle tracking echocardiography (2D-STE) with measurement of GLS, circumferential strain (CS) and twist mechanics. Patients were divided into two groups: with GLS≥-7 %, and GLS<-7 %. Results In a group with more reduced GLS≥-7% systolic parameters were worse, Table. Systolic velocities of medial and lateral mitral annulus (S’lat), and CS at the LV basal and mid levels (CSmid) were significantly more altered. Rotational parameters did not differ between the groups. In a multivariate regression model CSmid (p < 0.0001; B = 0.66, 95%CI [0.37 ÷ 0.95]), S’lat (p = 0.001; B=-0.34, 95%CI [-1.5÷-0.46]) and VCW (p = 0.002; B = 0.31, 95%CI [0.15 ÷ 0.66]) were independent predictors of GLS. ROC curves identified CSmid (AUC 0.91, p < 0.0001) and VCW (AUC 0.69, p = 0.02) as the best discriminators of patients with severely reduced GLS≥-7%. Conclusions Patients with DCM and HF with severely depressed LV function assessed by GLS were characterized with more altered CS and more pronounced MR. Rotational parameters failed to be significant determinants of LV performance. Echocardiographic parameters GLS≥-7% N = 24 GLS<-7% N = 28 p End diastolic volume index(ml/m²) 113.55 ± 41.64 87.98 ± 26.98 0.01 End systolic volume index(ml/m²) 84.50 ± 39.05 55.51 ± 21.93 0.001 Ejection fraction (%) 28 ± 8 35 ± 7 0.001 Systolic velocity of medial mitral annulus (cm/sec) 3.57 ± 0.81 4.88 ± 1.52 0.001 Systolic velocity of lateral mitral annulus (cm/sec) 4.38 ± 1.09 5.38 ± 1.42 0.014 Circumferential strain at basal level (%) -5.92 ± 3.15 55.52 ± 21.93 0.014 Circumferential strain at mid-level (%) -5.11 ± 1.77 -8.71 ± 2.34 <0.0001 Epicardial Torsion (°/cm) 0.31 ± 0.18 0.47 ± 0.35 0.05 Vena contracta width of mitral regurgitation (mm) 7.34 ± 2.23 5.58 ± 2.82 0.017 GLS - global longitudinal strain.

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1033 Prominent longitudinal strain involvement of left ventricular basal segments in native hypertensive patients without clear-cut hypertrophy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.627 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Lembo ◽

R Esposito ◽

C Santoro ◽

R Sorrentino ◽

F Luciano ◽

...

Keyword(s):

Arterial Hypertension ◽

Longitudinal Strain ◽

Linear Regression Analysis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Control Group ◽

Hypertensive Patients ◽

Clear Cut ◽

Lv Mass ◽

Significant Difference

Abstract Background Left ventricular (LV) global longitudinal strain (GLS) is able to detect an early subclinical dysfunction and it has been demonstrated to be a prognosticator in arterial hypertension. Information of regional longitudinal strain (LS) pattern has not been investigated in this clinical setting. Purpose We analyzed regional LV patterns of LS and base-to-apex behaviour of LS in newly diagnosed and never-treated hypertensive patients (HTN) without clear-cut LV hypertrophy (LVH). Methods 166 HTN (M/F = 107/59; age 43.9 ± 14.3 years, blood pressure [BP] = 146.5± 10.7/90.1 ± 7.5 mmHg) and a control group of 94 healthy subjects (M/F = 58/36; age 41.2 ± 15.0 years) underwent standard echo-Doppler exam, including speckle tracking quantification of regional LS and GLS (considered in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio - RRSR = [ALS/(BLS + MLS)] - were also computed. Exclusion criteria were LVH (LV mass index ≥45 g/m^2.7 in females and ≥49 g/m^2.7 in males), diabetes mellitus, coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. Results The two groups were comparable for sex, age, heart rate and LV ejection fraction (EF). Body mass index (BMI), systolic (SBP), diastolic (DBP) and mean BP (MBP) (all p < 0.0001), LV mass index (p = 0.03), relative wall thickness (RWT) (p < 0.02) and E/e’ ratio (p < 0.01) were higher, and GLS lower (21.6 ± 2.0 vs. 22.2 ± 2.1%, p < 0.02) in HTN. By analyzing regional LS, BLS (18.2 ± 2.1% vs. 19.2 ± 2.1%, p < 0.0001) and MLS (20.7 ± 2.0 vs. 21.4 ± 2.1%, p = 0.007) resulted significantly lower in HTN, without significant difference in ALS (26.0 ± 3.6 vs. 25.9 ± 3.8%, p = 0.98). Accordingly, RRSR was higher in HTN (0.67 ± 0.09 vs. 0.64 ± 0.09, p < 0.01). Even after excluding patients with LV concentric remodeling (RWT > 0.42) (n = 34), BLS (p < 0.0001) and MLS (p < 0.002) were again lower and RRSR (p < 0.01) higher in HTN than in controls. In the pooled population, BLS negatively correlated with SBP (r=-0.22), DBP (r=-0.25) and MBP (r=-0.26) (Figure) (all p < 0.0001). By a multiple linear regression analysis, after adjusting for age, sex, BMI and RWT, the association between BLS and MBP remained significant (β coefficient=-0.23, p < 0.0001), with an additional significant impact of male sex (β=-0.33, p < 0.0001) (cumulative R²=0.18, SEE = 1.9%, p < 0.0001). Conclusions Besides normal LV EF, GLS is lower in HTN. LS dysfunction involves basal and, with a lower extent, middle myocardial segments, with a compensation of apical segments. RRSR appears to be significantly higher in HTN. These results are even confirmed in hypertensive patients with normal LV geometry. The association of BLS and BP appears to be independent on several confounders. Regional LS pattern might be useful to detect very early LV systolic abnormalities in arterial hypertension. Abstract 1033 Figure. Relation between MBP and BLS

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