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Early predictors of left ventricular dysfunction in hypertensive patients: comparative cross-section study

Islam E Shehata1, Ahmed S Eldamanhory2, Ahmed Shaker2

  • 1Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt. iemshehata@zu.edu.eg.

The International Journal of Cardiovascular Imaging
|February 13, 2020
PubMed

Insights

Hypertension can cause subclinical left ventricular (LV) dysfunction. Global longitudinal strain (GLS) and early diastolic driving force (DF) are sensitive echocardiographic markers for predicting LV systolic and diastolic dysfunction in hypertensive patients.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Hypertension Research

Background:

  • Hypertension is a major risk factor for cardiovascular disease, often leading to left ventricular (LV) dysfunction.
  • Early detection of subclinical LV dysfunction in hypertensive patients is crucial for timely intervention and improved outcomes.
  • Traditional echocardiographic parameters may not sufficiently identify early-stage cardiac changes in hypertension.

Purpose of the Study:

  • To identify early echocardiographic markers of LV systolic and diastolic dysfunction in hypertensive patients.
  • To compare LV function parameters between hypertensive patients with preserved ejection fraction and normotensive controls.
  • To assess the predictive value of Global Longitudinal Strain (GLS) and Driving Force (DF) for subclinical LV dysfunction.

Main Methods:

  • A comparative cross-sectional study involving 100 patients (50 hypertensive, 50 normotensive).
  • 2D echocardiography was performed, analyzing parameters including LV mass index, relative wall thickness, ejection fraction (EF%), left atrial volume index (LAVI), and diastolic function (E, A, e' velocities, E/A, E/e' ratios).
  • Speckle tracking echocardiography was used to calculate Global Longitudinal Strain (GLS), and early diastolic Driving Force (DF) was computed.

Main Results:

  • Hypertensive patients showed significantly elevated LV mass, LA volume, and DF compared to controls.
  • Hypertensive patients exhibited reduced GLS magnitude, indicating impaired systolic function.
  • A GLS cutoff of > -18.1% accurately predicted subclinical LV systolic dysfunction, while a DF cutoff of ≥ 0.25 N predicted subclinical diastolic dysfunction.

Conclusions:

  • Global Longitudinal Strain (GLS) and Driving Force (DF) are sensitive echocardiographic markers for detecting early subclinical LV systolic and diastolic dysfunction in hypertensive individuals.
  • These parameters can aid in the early diagnosis and management of hypertensive heart disease, potentially leading to better patient outcomes.
  • The study highlights the utility of advanced echocardiographic techniques in risk stratification for hypertensive patients.

Keywords:
CardiomyopathyEarly diastolic driving forceHypertensionLeft ventricular dysfunctionSpeckle tracking

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