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Layer-specific systolic and diastolic strain in hypertensive patients with and without mild diastolic dysfunction

Echo Research & Practice volume 5, pages 41–49 (2018)Cite this article

Abstract

This study sought to examine layer-specific longitudinal and circumferential systolic and diastolic strain, strain rate (SR) and diastolic time intervals in hypertensive patients with and without diastolic dysfunction. Fifty-eight treated hypertensive patients were assigned to normal diastolic function (NDF, N = 39) or mild diastolic dysfunction (DD, N = 19) group. Layer-specific systolic and diastolic longitudinal and circumferential strains and SR were assessed. Results showed no between-group difference in left ventricular mass index (DD: 92.1 ± 18.1 vs NDF: 88.4 ± 16.3; P = 0.44). Patients with DD had a proportional reduction in longitudinal strain across the myocardium (endocardial for DD −13 ± 4%; vs NDF −17 ± 3, P < 0.01; epicardial for DD −10 ± 3% vs NDF −13 ± 3%, P < 0.01; global for DD: −12 ± 3% vs NDF: −15 ± 3, P = 0.01), and longitudinal mechanical diastolic impairments as evidenced by reduced longitudinal strain rate of early diastole (DD 0.7 ± 0.2 L/s vs NDF 1.0 ± 0.3 L/s, P < 0.01) and absence of a transmural gradient in the duration of diastolic strain (DD endocardial: 547 ± 105 ms vs epicardial: 542 ± 113 ms, P = 0.24; NDF endocardial: 566 ± 86 ms vs epicardial: 553 ± 77 ms, P = 0.03). Patients with DD also demonstrate a longer duration of early circumferential diastolic strain (231 ± 71 ms vs 189 ± 58 ms, P = 0.02). In conclusion, hypertensive patients with mild DD demonstrate a proportional reduction in longitudinal strain across the myocardium, as well as longitudinal mechanical diastolic impairment, and prolonging duration of circumferential mechanical relaxation.

References

  1. Plaksej R, Kosmala W, Frantz S, Herrmann S, Niemann M, Stork S, Wachter R, Angermann CE, Ertl G, Bijnens B, et al. Relation of circulating markers of fibrosis and progression of left and right ventricular dysfunction in hypertensive patients with heart failure. Journal of Hypertension 200927 2483–2491. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0b013e3283316c4d)

    Article  CAS  Google Scholar 

  2. Berk BC, Fujiwara K & Lehoux S. ECM remodeling in hypertensive heart disease. Jounal of Clinical Investigation 2007117 568–575. https://doiorg.publicaciones.saludcastillayleon.es/10.1172/JCI31044)

    Article  CAS  Google Scholar 

  3. Szelényi Z, Fazakas Á, Szénási G, Tegze N, Fekete B, Molvarec A, Hadusfalvy-Sudár S, Jánosi O, Kiss M, Karádi I, et al. The mechanism of reduced longitudinal left ventricular systolic function in hypertensive patients with normal ejection fraction. Journal of Hypertension 201533 1962–1969.

    Article  Google Scholar 

  4. Saghir M, Areces M & Makan M. Strain rate imaging differentiates hypertensive cardiac hypertrophy from physiologic cardiac hypertrophy. Journal of the American Society of Echocardiography 200720 151–157. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.echo.2006.08.006)

    Article  Google Scholar 

  5. Ishizu T, Seo Y, Kameda Y, Kawamura R, Kimura T, Shimojo N, Xu D, Murakoshi N & Aonuma K. Left ventricular strain and transmural distribution of structural remodeling in hypertensive heart disease. Hypertension 201463 500–506. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/HYPERTENSIONAHA.113.02149)

    Article  CAS  Google Scholar 

  6. Tadic M & Cuspidi C. Multilayer strain: a powerful tool to be used with caution. Journal of Hypertension 201735 198. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0000000000001096)

    Article  CAS  Google Scholar 

  7. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal–Cardiovascular Imaging 201629 277–313. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.echo.2016.01.011)

    Google Scholar 

  8. Ting SM, Hamborg T, McGregor G, Oxborough D, Lim K, Koganti S, Aldridge N, Imray C, Bland R, Fletcher S, et al. Reduced cardiovascular reserve in chronic kidney failure: a matched cohort study. American Journal of Kidney Diseases 201566 274–284. https://doiorg.publicaciones.saludcastillayleon.es/10.1053/j.ajkd.2015.02.335)

    Article  Google Scholar 

  9. Lang RM, Bandano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal–Cardiovascular Imaging 20156 233–271. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.echo.2014.10.003)

    Article  Google Scholar 

  10. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM & Tajik AJ. Clinical utility of Doppler echocardiography and Doppler tissue imaging in the estimation of left ventricular filling pressures. Circulation 2000102 1788–1794. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/01.CIR.102.15.1788)

    Article  CAS  Google Scholar 

  11. Oxborough D, Shave R, Warburton D, Williams K, Oxborough A, Charlesworth S, Foulds H, Hoffman MD, Birch K & George K. Dilatation and dysfunction of the right ventricle immediately following ultra-endurance exercise: exploratory insights from conventional 2-dimensional and speckle tracking echocardiography. Circulation: Cardiovascular Imaging 20114 256–263. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/CIRCINTERVENTIONS.110.959718)

    Google Scholar 

  12. Shi J, Pan C, Kong D, Cheng L & Shu X. Left ventricular longitudinal and circumferential layer‐specific myocardial strains and their determinants in healthy subjects. Echocardiography 201533 510–518. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/echo.13132)

    Article  Google Scholar 

  13. Wang J, Khoury DS, Yue Y,, Torre-Amione G & Nagueh SF. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. European Heart Journal 200829 1283–1290. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/eurheartj/ehn141)

    Article  CAS  Google Scholar 

  14. Lee WH, Liu YW, Yang LT & Tsai WC. Prognostic value of longitudinal strain of subepicardial myocardium in patients with hypertension. Journal of Hypertension 201634 1195–1200. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/HJH.0000000000000903)

    Article  CAS  Google Scholar 

  15. Kim SA, Park SM, Kim MN & Shim WJ. Assessment of left ventricular function by layer-specific strain and its relationship to structure remodeling in patients with hypertension. Canadian Journal of Cardiology 201632 211–216. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.cjca.2015.04.025)

    Article  Google Scholar 

  16. Huang J, Yan ZN, Rui YF, Fan L, Shen D & Chen DL. Left ventricular systolic function changes in primary hypertension patients detected by the strain of different myocardium layers. Medicine 201695 e2440. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/MD.0000000000002440)

    Article  Google Scholar 

  17. Tadic M, Cuspidi C, Ivanovic B, Ilic I, Celic V & Kocijancic V. Influence of white-coat hypertension on left ventricular deformation 2-and 3-dimensional speckle tracking study: novelty and significance. Hypertension 201667 592–596. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/HYPERTENSIONAHA.115.06822)

    Article  CAS  Google Scholar 

  18. Galderisi M, Lomoriello VS, Santoro A, Esposito R, Olibet M, Raia R, Di Minno MN, Guerra G, Mele D & Lombardi G. Differences of myocardial systolic deformation and correlates of diastolic function in competitive rowers and young hypertensives: a speckle-tracking echocardiography study. Journal of the American Society of Echocardiography 201023 1190–1198. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.echo.2010.07.010)

    Article  Google Scholar 

  19. Kang SJ, Lim HS, Choi BJ, Hwang GS, Yoon MH, Tahk SJ & Shin JH. Longitudinal strain and torsion assessed by two-dimensional speckle tracking correlate with the serum level of tissue inhibitor of matrix metalloproteinase-1, a marker of myocardial fibrosis, in patients with hypertension. Journal of the American Society of Echocardiography 200821 907–911. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.echo.2008.01.015)

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank Adele Oxborough for providing technical support for data analysis.

Funding

This project was funded by The British Heart Foundation (BHF) Grant (PG/11/66/28982). The BHF did not have any role in study design; collection, analysis and interpretation of data; writing the report and the decision to submit the report for publication.

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Authors and Affiliations

  1. Department of Kinesiology, Brock University, St Catharines, Ontario, Canada

    Hisham Sharif PhD & David Ditor PhD

  2. Health Sciences, Brock University, St Catharines, Ontario, Canada

    Deborah O’Leary PhD

  3. Division of Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

    Stephen Ting MRCP PhD & Daniel Zehnder MD PhD

  4. Division of Metabolic and Vascular Health, The University of Warwick, Coventry, UK

    Stephen Ting MRCP PhD

  5. Department of Acute Medicine, Heart of England NHS Foundation Trust, Birmingham, UK

    Stephen Ting MRCP PhD

  6. Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK

    Lynsey Forsythe MSc, Keith George PhD & David Oxborough PhD

  7. Centre for Applied Biological and Exercise Sciences, Coventry University, UK

    Gordon McGregor PhD

  8. Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK

    Prithwish Banerjee MD

  9. Brock-Niagara Centre for Health and Well-Being, Brock University, St Catharines, Ontario, Canada

    Deborah O’Leary PhD & David Ditor PhD

  10. Department of Acute Medicine, North Cumbria University Hospital NHS Trust, Carlisle, UK

    Daniel Zehnder MD PhD

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  1. Hisham Sharif PhD
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  2. Stephen Ting MRCP PhD
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  3. Lynsey Forsythe MSc
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  10. David Oxborough PhD
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Correspondence to Hisham Sharif PhD.

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Sharif, H., Ting, S., Forsythe, L. et al. Layer-specific systolic and diastolic strain in hypertensive patients with and without mild diastolic dysfunction. Echo Res Pract 5, 41–49 (2018). https://doiorg.publicaciones.saludcastillayleon.es/10.1530/ERP-17-0072

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1530/ERP-17-0072

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Echo Research & Practice

ISSN: 2055-0464

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