SUBCLINICAL SYSTOLIC DYSFUNCTION AMONG NEWLY DIAGNOSED HYPERTENSIVES WITH PRESERVED LEFT VENTRICULAR EJECTION FRACTION USING TWO DIMENSIONAL STRAIN IMAGING METHOD: HOSPITAL BASED OBSERVATIONAL STUDY

Abstract

Background: Heart failure is the major cause of morbidity and mortality in hypertension. Early detection of sub- clinical systolic heart failure thus is an important step in prevention of clinical heart failure. There are limited studies evaluating the presence and determinants of subclinical heart failure along axial, circumferential and radial axis among hypertensives with normal Left Ventricular Ejection Fraction (LVEF) using strain imaging methods. Present study aimed to detect the subclinical global and regional systolic dysfunction in longitudinal, circumferential and radial axis and its determinants in hypertensive patients with normal LVEF.

Material and Method: 2-dimensional echocardiographic (2DE) images of the Left Ventricle (LV) were acquired in apical 4-chamber and parasternal short-axis view at mid ventricular levels to assess global and regional strain in lon- gitudinal, radial and circumferential axis in 72 hypertensive patients with normal LVEF and 57 healthy controls us- ing speckle tracking method. LV Mass and LVEF were measured using 2D guided M Mode scan and diastolic func- tion was assessed in early diastole with tissue Doppler imaging.

Results: The regional strain in longitudinal axis was significantly reduced at Apex and Apico lateral segment of LV in hypertensive population compared to normotensive group (-17.99± 5.21 Vs-19.77±4.17; p<0.01 and -14.78 ±5.69 Vs -17.40± 5.23; p<0.01) respectively. However the mean Global Longitudinal and circumferential systolic Strain was not significantly reduced in the hypertensive group when compared to the normotensive group.

Conclusions: The regional LV systolic function in longitudinal axis at apex and apico lateral wall was significantly reduced while the global systolic function in longitudinal and circumferential axis was preserved in hypertensive patients compared to normotensive healthy individuals.