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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Influence of White-Coat Hypertension on Left Ventricular Deformation 2- and 3-Dimensional Speckle Tracking Study
Marijana Tadic1, Cesare Cuspidi2, Branislava Ivanovic2
1From the Cardiology Department, University Clinical Hospital Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia (M.T., I.I., V.C., V.K.); Department of Cardiology, Faculty of Medicine, Belgrade, Serbia (M.T., B.I., V.C.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.). marijana_tadic@hotmail.com.
Insights
White-coat hypertension, a condition with elevated office blood pressure but normal ambulatory readings, impairs left ventricular deformation. This study found reduced longitudinal and circumferential strain in these patients compared to normotensive and sustained hypertensive individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Medical Imaging
Background:
- White-coat hypertension (WCH) is characterized by elevated clinic blood pressure (BP) with normal out-of-office BP.
- The impact of WCH on cardiac structure and function, particularly left ventricular (LV) deformation, requires further elucidation.
- Understanding subclinical cardiac changes in WCH is crucial for risk stratification.
Purpose of the Study:
- To compare left ventricular deformation parameters in patients with WCH against normotensive controls and sustained hypertensive patients.
- To investigate the effects of WCH on myocardial strain using 2D and 3D echocardiography.
- To assess differences in LV strain across different myocardial layers.
Main Methods:
- Cross-sectional study of 139 untreated subjects.
- 24-hour ambulatory blood pressure monitoring (ABPM) and clinical BP measurements.
- 2D and 3D echocardiography including multilayer strain analysis.
Main Results:
- LV longitudinal and circumferential strains progressively decreased from normotensive to WCH to sustained hypertensive groups.
- Subendocardial and mid-myocardial longitudinal and circumferential strains showed a similar gradual decrease.
- LV radial strain and 3D area strain did not differ significantly between the groups.
- Subepicardial longitudinal and circumferential strains were comparable across all groups.
Conclusions:
- White-coat hypertension significantly impacts left ventricular deformation.
- Subtle but significant changes in LV strain occur even with WCH, detectable by advanced echocardiographic techniques.
- These findings suggest WCH may represent an early stage of hypertensive cardiac involvement.
Abstract:
We sought to compare left ventricular deformation in subjects with white-coat hypertension to normotensive and sustained hypertensive patients. This cross-sectional study included 139 untreated subjects who underwent 24-hour ambulatory blood pressure monitoring and completed 2- and 3-dimensional examination. Two-dimensional left ventricular multilayer strain analysis was also performed. White-coat hypertension was diagnosed if clinical blood pressure was elevated and 24-hour blood pressure was normal. Our results showed that left ventricular longitudinal and circumferential strains gradually decreased from normotensive controls across subjects with white-coat hypertension to sustained hypertensive group. Two- and 3-dimensional left ventricular radial strain, as well as 3-dimensional area strain, was not different between groups. Two-dimensional left ventricular longitudinal and circumferential strains of subendocardial and mid-myocardial layers gradually decreased from normotensive control to sustained hypertensive group. Longitudinal and circumferential strains of subepicardial layer did not differ between the observed groups. We concluded that white-coat hypertension significantly affects left ventricular deformation assessed by 2-dimensional traditional strain, multilayer strain, and 3-dimensional strain.
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