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Yang Y, Li Y, Zhu L, Xu J, Tang X, Gao P. Blood pressure control and left ventricular echocardiographic progression in hypertensive patients: an 18-month follow-up study. Front Cardiovasc Med 2023; 10:1161993. [PMID: 37564911 PMCID: PMC10410104 DOI: 10.3389/fcvm.2023.1161993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Objectives The impact of blood pressure (BP) control and its timing on left ventricular (LV) structure and function remains unclear. The present study was to evaluate whether BP control correlated with conventional LV geometry and function indexes or global longitudinal strain (GLS) progression, and when echocardiographic changes would occur in essential hypertension. Methods and results A total of 62 participants (mean age 55.2 ± 11.5, male 71.0%) with uncontrolled hypertension were enrolled in the longitudinal study. Patients were followed up at the 6-month and 18-month, when echocardiographic measurements were performed and BP control was evaluated during the follow up period. At the 6- and 18-month examination, we divided the hypertensive patients into two groups as BP controlled and uncontrolled group. Patients with BP uncontrolled (n = 33) had higher LV mass index (P = 0.02), higher left atrial volume index (P = 0.01), worse GLS (P = 0.005) and GLS changes (P = 0.003) compared with controlled BP (n = 29) at the 6-month follow-up examination. Patients with uncontrolled BP (n = 25) had higher LV mass index (P = 0.001), higher LV mass index changes (P = 0.01), higher relative wall thickness (P = 0.01), higher E/e' (P = 0.046), worse GLS (P = 0.02) and GLS changes (P = 0.02) compared to BP controlled group (n = 24) at the 18-month follow-up examination. GLS changes were associated with BP control (β = 0.370, P = 0.004 at the 6-month examination and β = 0.324, P = 0.02 at the 18-month examination, respectively) in stepwise multivariate regression analysis. LV mass index changes was corelated with systolic BP (β = 0.426, P = 0.003) at the 18-month follow-up examination in stepwise multivariate regression analysis. Neither was GLS changes nor LV mass index changes were related to antihypertensive medication class, including combination therapy in 6- or 18-month follow up examination. Conclusions Our findings offer new clinical evidence on the association of BP control with echocardiographic changes in hypertensive patients, and, in particular, support the view that GLS progression was earlier and subtler than conventional LV geometry and function parameters. GLS changes were significant between BP controlled and uncontrolled patients even in 6-month follow-up period.
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Affiliation(s)
- Yan Yang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Zhu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianzhong Xu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Tang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pingjin Gao
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Laboratory of Vascular Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
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Vishvak Chanthar KMM, Khanna R, Agarwal G, Rout SR, Kapoor A, Sabaretnam M, Chand G, Mishra A, Agarwal A, Mishra SK. Cardiac Changes and Their Reversal Following Curative Surgery in Pheochromocytoma: PheoCard Prospective Cohort Study. World J Surg 2023; 47:304-311. [PMID: 36210362 DOI: 10.1007/s00268-022-06731-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pheochromocytoma and paraganglioma (PPGL) are catecholamine producing tumors of chromaffin cell origin, known to cause varied cardiovascular manifestations from hypertension to myocardial infarction. This study sought to objectively evaluate the cardiac changes in PPGL patients and their reversal following curative surgery. METHODS The PheoCard study was registered in ClinicalTrials.gov (NCT05082311) and involved 35 consecutive PPGL patients managed as per standard protocol involving alpha blockade followed by curative surgery. They underwent detailed cardiac evaluation using 2D-echocardiography and speckle tracking echocardiography at the time of diagnosis, 7-10 days after alpha blockade, and at 7 days, 3 months, and 6 months after surgical removal. Age- and gender-matched essential hypertensives and healthy individuals (10 in each group) served as two control groups. RESULTS Patients with PPGLs had significantly higher mean blood pressure, left ventricle end-diastolic dimension and volume (LVEDD, LVEDV), left ventricle end-systolic volume (LVESV), septal wall thickness, LV hypertrophy, lower mean LV ejection fraction (LVEF), early diastolic mitral annular velocity (E/A), decreased amplitude of LV longitudinal strain, and increased circumferential strain (p < 0.001) when compared with the control groups at baseline. After alpha blockade, there was marked reduction in the mean LVEDD, LVEDV, LVESV, and normalization of E/A ratio (p < 0.001) in the PPGL patients. Following curative surgery (normalization of fractionated urinary metanephrines at 7-10 days post-operatively), there was early improvement in all echocardiographic parameters and it continued to improve even at 6 months after surgery. There was marked improvement in the global longitudinal strain as seen on serial speckle tracking echocardiography with recovery of most of the segments of LV depicting the reversal of subclinical endocardial dysfunction (p < 0.001). CONCLUSION PPGL patients despite normal systolic function have subclinical LV diastolic dysfunction which is reversed after curative surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT05082311.
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Affiliation(s)
- K M M Vishvak Chanthar
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Gaurav Agarwal
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Smarak Ranjan Rout
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - M Sabaretnam
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Gyan Chand
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Anjali Mishra
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Amit Agarwal
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Saroj K Mishra
- Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
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Tamarappoo B, Samuel TJ, Elboudwarej O, Thomson LEJ, Aldiwani H, Wei J, Mehta P, Cheng S, Sharif B, AlBadri A, Handberg EM, Petersen J, Pepine CJ, Nelson MD, Bairey Merz CN. Left ventricular circumferential strain and coronary microvascular dysfunction: A report from the Women's Ischemia Syndrome Evaluation Coronary Vascular Dysfunction (WISE-CVD) Project. Int J Cardiol 2021; 327:25-30. [PMID: 33202262 PMCID: PMC8061637 DOI: 10.1016/j.ijcard.2020.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/22/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
AIMS Women with ischemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Left ventricular (LV) circumferential strain (CS) is often lower in INOCA compared to healthy controls; however, it remains unclear whether CS differs between INOCA women with and without CMD. We hypothesized that CS would be lower in women with CMD, consistent with CMD-induced LV mechanical dysfunction. METHODS AND RESULTS Cardiac magnetic resonance (cMR) images were examined from women enrolled in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction Project. CS by feature tracking in INOCA women with CMD, defined as myocardial perfusion reserve index (MPRI) <1.84 during adenosine-stress perfusion cMR, was compared with CS in women without CMD. In a subset who had invasive coronary function testing (CFT), the relationship between CS and CFT metrics, LV ejection fraction (LVEF) and cardiovascular risk factors was investigated. Among 317 women with INOCA, 174 (55%) had CMD measured by MPRI. CS was greater in women with CMD compared to those without CMD (23.2 ± 2.5% vs. 22.1 ± 3.0%, respectively, P = 0.001). In the subset with CFT (n = 153), greater CS was associated with increased likelihood of reduced vasodilator capacity (OR = 1.33, 95%CI = 1.02-1.72, p = 0.03) and discriminated abnormal vs. normal coronary vascular function compared to CAD risk factors, LVEF and LV concentricity (AUC: 0.82 [0.73-0.96 95%CI] vs. 0.65 [0.60-0.71 95%CI], respectively, P = 0.007). CONCLUSION The data indicate that LV circumferential strain is related to and predicts CMD, although in a direction contrary with our hypothesis, which may represent an early sign of LV mechanical dysfunction in CMD.
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Affiliation(s)
- Balaji Tamarappoo
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - T Jake Samuel
- The University of Texas at Arlington, Arlington, TX, USA
| | - Omeed Elboudwarej
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Louise E J Thomson
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Haider Aldiwani
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Puja Mehta
- Emory Women's Heart Center, Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA
| | - Susan Cheng
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ahmed AlBadri
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Eileen M Handberg
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - John Petersen
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Carl J Pepine
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael D Nelson
- The University of Texas at Arlington, Arlington, TX, USA.; Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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Prominent basal and middle strain longitudinal involvement in newly-diagnosed and never treated hypertensive patients without clear-cut hypertrophy. Int J Cardiol 2020; 304:179-184. [DOI: 10.1016/j.ijcard.2020.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/18/2019] [Accepted: 01/15/2020] [Indexed: 01/20/2023]
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Shiino K, Yamada A, Scalia GM, Putrino A, Chamberlain R, Poon K, Walters DL, Chan J. Early Changes of Myocardial Function After Transcatheter Aortic Valve Implantation Using Multilayer Strain Speckle Tracking Echocardiography. Am J Cardiol 2019; 123:956-960. [PMID: 30594290 DOI: 10.1016/j.amjcard.2018.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective therapeutic option for severe symptomatic aortic valve stenosis (AS) with intermediate or high surgical risk. The purpose of this study was to examine the effects of TAVI on left ventricular (LV) mechanics using multilayer global longitudinal strain (GLS) by 2D speckle-tracking echocardiography. A total of 119 patients (mean age 83 ± 7.0 years, male 54%) with severe symptomatic AS and normal LV ejection fraction (LVEF) underwent echocardiography at baseline and 1 month after TAVI. Global longitudinal strain was measured from the endocardial layer (GLSendo), mid-ventricular layer (GLSmyo), epicardial layer (GLSepi) and full thickness of myocardium (GLSwhole). There was significant improvement in all 3 layers of GLS after TAVI compared with baseline, but there was no significant change in LVEF. The relative % increment in GLS in each layer strain were 11.2 ± 23.4% (GLSendo), 13.4 ± 33.0% (GLSmyo) and 18.0 ± 46.6% (GLSepi) with significant difference between GLSendo and GLSepi (p < 0.05). In conclusion, multilayer GLS is more sensitive than conventional LVEF to detect early improvement in LV systolic function after TAVI in patients with severe AS. There is a disproportional improvement in different layers with least improvement in the endocardium. Multilayer strain analysis may provide new insights into understanding mechanics of AS.
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Abstract
PURPOSE OF REVIEW To review recent advances in the imaging of hypertensive heart disease (HHD) with an emphasis on developments in the imaging of diffuse myocardial fibrosis using cardiac magnetic resonance (CMR). RECENT FINDINGS HHD results from long-standing hypertension and is characterized by the development of left ventricular hypertrophy and diffuse interstitial fibrosis. Diffuse fibrosis traditionally required endomyocardial biopsy to diagnose, but recent developments using T1 mapping in CMR allow for noninvasive assessment. Studies using T1 mapping have shown an increase in extracellular volume fraction (ECV) in patients with HHD compared to normal controls, suggesting ECV can be used as a noninvasive marker for fibrosis in HHD. In addition to T1 mapping, other recent advances in HHD imaging include improvements in three-dimensional echocardiography, allowing for accurate real-time volumetric measurements, and the use of speckle tracking echocardiography to detect subclinical systolic dysfunction. Measurement of ECV using T1 mapping in CMR can be used as a noninvasive marker of diffuse myocardial fibrosis in HHD. While further studies are needed to validate this approach with larger patient cohorts, ECV can potentially be used to both monitor disease progression and assess therapeutic interventions in HHD.
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Affiliation(s)
| | - Nicholas R Jaeger
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Christopher M Kramer
- Department of Cardiology, University of Virginia, Charlottesville, VA, USA.
- Department of Radiology, University of Virginia, Charlottesville, VA, USA.
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Ali SI, Li Y, Adam M, Xie M. Evaluation of Left Ventricular Systolic Function and Mass in Primary Hypertensive Patients by Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:39-49. [PMID: 30027675 DOI: 10.1002/jum.14687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 06/08/2023]
Abstract
Hypertension is an independent risk factor for cardiovascular diseases. The accurate evaluation of cardiovascular risk is of paramount importance in the management of hypertensive patients. Conventional echocardiographic methods have provided the assessment of left ventricular systolic function and mass for many years. Tissue Doppler imaging, 3-dimensional echocardiography, and speckle tracking echocardiography are newer echocardiographic modalities for the left ventricular systolic function and mass quantification. The major emphasis of this review is to evaluate the left ventricular systolic function and mass by conventional and newly developed echocardiographic in hypertensive patients.
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Affiliation(s)
- Shima Ibrahim Ali
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum North, Sudan
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mohamed Adam
- Colleges of Applied Medical Science, Radiology Department, King Khalid University, Kingdom of Saudi Arabia
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Xu TY, Yang Y, Li JJ, Li Y, Wang JG. Left ventricular deformation in relation to the geometric pattern in hypertensive patients. Medicine (Baltimore) 2019; 98:e14257. [PMID: 30681621 PMCID: PMC6358350 DOI: 10.1097/md.0000000000014257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to evaluate left ventricular deformation in relation to the geometric pattern in hypertensive patients with normal left ventricular ejection fraction using speckle tracking echocardiography (STE).Transthoracic echocardiography was performed in 80 hypertensive patients and 50 age- and gender-matched normotensive subjects. Left ventricular geometric pattern was defined according to left ventricular mass index and relative wall thickness as normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. Quantitative measurements of longitudinal, circumferential, and radial strain were performed for endocardial, middle, and epicardial layers of the left ventricular wall at each segment.The longitudinal strain in hypertension was lower for all 3 layers in concentric (n = 20) and eccentric hypertrophy (n = 20) than normotensive subjects (n = 50, P < .01). It was also significantly lower for the endocardial layer in concentric remodeling (n = 20, P = .04 vs normotensive subjects). The circumferential strain in hypertension was higher in normal geometry or concentric remodeling, lower in concentric hypertrophy, and at similar level in eccentric hypertrophy, in comparison with normotensive subjects. The difference from normotensive subjects was statistically significant for the endocardial and middle layers in normal geometry (P < .03), for the endocardial layer in concentric remodeling (P < .02), and for the middle and epicardial layers in concentric hypertrophy (P≤.001). The radial strain and twist did not differ between normotensive and hypertensive subjects (P > .08).Left ventricular deformation in hypertension occurs with various geometric patterns disproportionately in the endocardial, middle and epicardial layers and differently in the longitudinal and circumferential orientations.
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Sun JP, Xu TY, Ni XD, Yang XS, Hu JL, Wang SC, Li Y, Bahler RC, Wang JG. Echocardiographic strain in hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy. Echocardiography 2018; 36:257-265. [PMID: 30561121 DOI: 10.1111/echo.14222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The myocardial structure differs between secondary left ventricular hypertrophy (LVH) and hypertrophic cardiomyopathy (HCM). We investigated left ventricular function of these two types of hypertrophy using multilayer strain analysis with two-dimensional echocardiography. METHODS Transthoracic echocardiography (Vivid-E9) was performed in 240 patients with preserved left ventricular ejection fraction (LVEF ≥50%) and with either HCM (n = 80, 63 men, age 49.8 ± 14.1 years), hypertensive LVH (n = 80, 63 men, age 51.4 ± 13.3 years) or normal blood pressure and left ventricular structure (n = 80, 63 men, 50.8 ± 12.4 years). Quantitative multilayer longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were analyzed. The ratio of endo-/epi-myocardial strain was calculated. RESULTS Longitudinal strain was significantly (P < 0.001) lower in HCM patients than normal controls (15.2 ± 4.2% vs 23.1 ± 2.7%), especially in hypertrophic segments (14.5 ± 4.4% vs 17.2 ± 3.2% in nonhypertrophic segments, P < 0.01). LS was lower in patients with hypertensive LVH, similarly in all left ventricular segments (20.7 ± 3.7%, P < 0.001 vs controls). CS was lower in the mid- and epicardium (P < 0.01), but not endocardium in HCM (P = 0.4), and preserved in all myocardial layers in hypertensive LVH. The endo-/epi-myocardial ratios of both LS and CS were higher in HCM than hypertensive LVH (P < 0.01). RS was higher (P < 0.01) in HCM than hypertensive LVH and controls. Endocardial CS and global RS were correlated with LVEF (r ≥ 0.32, P < 0.01). CONCLUSIONS Hypertrophic cardiomyopathy patients had marked reductions in LS and CS, whereas patients with hypertensive LVH had less reduction in LS and preserved CS. The increased endo-/epi-myocardial ratios of LS and CS may be useful in differentiating HCM from hypertensive LVH.
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Affiliation(s)
- Jing-Ping Sun
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting-Yan Xu
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xian-Da Ni
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xing-Sheng Yang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun-Li Hu
- Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Shao-Chun Wang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Li
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Robert C Bahler
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ji-Guang Wang
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Modin D, Biering-Sørensen SR, Mogelvang R, Landler N, Jensen JS, Biering-Sørensen T. Prognostic Value of Echocardiography in Hypertensive Versus Nonhypertensive Participants From the General Population. Hypertension 2018; 71:742-751. [PMID: 29483222 DOI: 10.1161/hypertensionaha.117.10674] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/08/2017] [Accepted: 01/21/2018] [Indexed: 11/16/2022]
Abstract
Hypertension may be the most significant cardiovascular risk factor. Few studies have assessed the prognostic value of echocardiography in hypertensive individuals. This study examines the incremental prognostic value of adding echocardiographic parameters to established risk factors in individuals from the general population with and without hypertension. A total of 1294 individuals from the general population underwent a health examination and an echocardiogram including 2-dimensional speckle tracking. Outcome was a composite of ischemic heart disease and heart failure. The prevalence of hypertension was 38.3%. During a median follow-up of 12.5 years (interquartile range, 9.4-12.8 years), 222 participants (17.2%) developed the outcome. Out of these 222 events, 145 (65%) occurred in hypertensive participants, whereas 77 (35%) occurred in nonhypertensive individuals, corresponding to an incidence rate of 32/(1000×person-years) and 8/(1000×person-years), respectively. Follow-up was 100%. After multivariable adjustment, only left ventricular mass index predicted the outcome in hypertensive individuals, whereas only global longitudinal strain predicted the outcome in nonhypertensive individuals. In hypertensive individuals the prognostic value of left ventricular mass index was incremental to SCORE and abnormal ECG status. In nonhypertensive individuals the prognostic value of global longitudinal strain was incremental to SCORE and abnormal ECG status. The prognostic value of echocardiography in predicting cardiovascular outcomes in the general population is altered by hypertension. In hypertensive individuals, left ventricular mass index added incremental prognostic value in addition to established risk factors. In nonhypertensive individuals, global longitudinal strain added incremental prognostic value in addition to established risk factors.
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Affiliation(s)
- Daniel Modin
- From the Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., N.L., J.S.J., T.B.-S.) and Institute of Clinical Medicine (J.S.J.), University of Copenhagen, Denmark.
| | - Sofie Reumert Biering-Sørensen
- From the Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., N.L., J.S.J., T.B.-S.) and Institute of Clinical Medicine (J.S.J.), University of Copenhagen, Denmark
| | - Rasmus Mogelvang
- From the Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., N.L., J.S.J., T.B.-S.) and Institute of Clinical Medicine (J.S.J.), University of Copenhagen, Denmark
| | - Nino Landler
- From the Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., N.L., J.S.J., T.B.-S.) and Institute of Clinical Medicine (J.S.J.), University of Copenhagen, Denmark
| | - Jan Skov Jensen
- From the Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., N.L., J.S.J., T.B.-S.) and Institute of Clinical Medicine (J.S.J.), University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- From the Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., N.L., J.S.J., T.B.-S.) and Institute of Clinical Medicine (J.S.J.), University of Copenhagen, Denmark
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Luo XX, Zhu Y, Sun Y, Ge Q, Su J, So HK, Yam MC, Fang F. Does Masked Hypertension Cause Early Left Ventricular Impairment in Youth? Front Pediatr 2018; 6:167. [PMID: 29951474 PMCID: PMC6008558 DOI: 10.3389/fped.2018.00167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/21/2018] [Indexed: 11/20/2022] Open
Abstract
Objectives: Masked hypertension (MH) is not uncommon in the youth and may increase risks of long-term cardiovascular impairment. However, little is known about the subclinical heart damage in this group of patients. Currently, 3-layer speckle tracking imaging based on two-dimensional echocardiography is feasible to detect the early signs of myocardial damage. We therefore aimed to investigate whether subtle changes of cardiac function occurred in the young MH patients by using advanced quantification with layer-specific speckle tracking. Methods: A total of 40 adolescents with MH (age 18 ± 3 years, 73% males) and 40 age-, gender-, race-, and height-matched normotensive volunteers were enrolled in our study. MH was defined as one or more of the ambulatory blood pressure (BP) parameters (24-h, daytime and night-time average BPs) higher than ≥ 95th percentile for gender and height according to the local reference. Both comprehensive two-dimensional echocardiography with layer-specific strain analysis and 24-h ambulatory BP monitoring were performed. Longitudinal strain and circumferential strain in endocardial, mid-myocardial, and epicardial layers were determined accordingly with the dedicated software (EchoPAC software version 201, GE Healthcare, Horten, Norway). Results: Compared with normotensive controls, youths with MH had higher ambulatory pulse rate and left ventricular mass index, and were more obese. Interestingly, similar ventricular volumes and ejection fraction were observed in the study groups, but further analysis with layer-specific strains revealed that endocardial and mid-myocardial longitudinal and circumferential mechanical function were decreased in the young MH subjects when compared to normotensive individuals (all p < 0.05). However, there were no difference regarding radial strain and apical rotation derived from traditional speckle tracking analysis. Conclusion: Subclinical change of LV mechanic function assessed by layer-specific speckle tracking is present in youth with MH despite considered as normal with conventional ways.Thus, MH in youth should be monitored closely instead of labeling as an entirely benign entity.
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Affiliation(s)
- Xiu-Xia Luo
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yongsheng Zhu
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yiqian Sun
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Quanrong Ge
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Jin Su
- Department of Ultrasonography, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Hung-Kwan So
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Man-Ching Yam
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Fang Fang
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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12
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Ding L, Zhu WL, Zeng ZP, Li HZ, Ji J, Fang LG, Sun JP. Subclinical left ventricular systolic dysfunction detected by two-dimensional speckle tracking echocardiography in patients with pheochromocytoma and paraganglioma and preserved ejection fraction. Echocardiography 2017; 35:184-189. [PMID: 29168209 DOI: 10.1111/echo.13752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Li Ding
- Department of Cardiology; Peking Union Medical College Hospital; Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Wen Ling Zhu
- Department of Cardiology; Peking Union Medical College Hospital; Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Zheng Pei Zeng
- Department of Endocrinology; Peking Union Medical College Hospital; Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Han Zhong Li
- Department of Urology; Peking Union Medical College Hospital; Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Jin Ji
- Department of Cardiology; Peking Union Medical College Hospital; Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Li Gang Fang
- Department of Cardiology; Peking Union Medical College Hospital; Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Jing Ping Sun
- Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
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13
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Ping Sun J, Sheng Yang X, Wang S. The Role of Echocardiography in Hypertrophic Cardiomyopathy. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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