Abstract 11659: Noninvasive Assessment of Left Ventricular Diastolic Function in Hypertension by Novel One-Beat Real-Time Three-Dimensional Speckle Tracking Echocardiography With High Volume Rates
Background: Left ventricular (LV) pressure overload causes LV hypertrophy (LVH), which leads to reduced relaxation and compliance and may result in heat failure with preserved ejection fraction (HFpEF). LV strain rate (SR) during isovolumic relaxation (SR-IVR) by 2-dimensional speckle tracking echocardiography (2D-STE) was reported as a good index of the time constant of pressure decline. However, heart mechanics in multiple dimensions seem to be best represented by 3D-STE. Thus, we developed novel 3D-STE with high volume rates to measure global myocardial SR and examine diastolic function.
Methods: HTN patients with preserved EF>50% (age 69±7) were divided into 5 groups (A: normal geometry, n=25; B: concentric remodeling, n=20; C: concentric LVH, n=24; D: eccentric LVH, n=21; and E: HFpEF, n=17). We measured SR-IVR as an index of LV relaxation and strain by novel 3D-STE in HTN patients and control (n=60, age 69±9). Pulmonary capillary wedge pressure (PCWP) was estimated as 10.7 - 12.4 x log [left atrial (LA) active emptying function / minimum LA volume], as we previously reported. LV diastolic stress (DS) was calculated as radius x PCWP / thickness. We estimated LV stiffness as DS / radial strain.
Results: LV mass increased in HTN with LVH and HFpEF compared with controls. LV radial SR-IVR in HTN decreased even in normal geometry compared with controls (controls: -0.95±0.56; A: -0.66±0.44*; B: -0.65±0.32*; C: -0.52±0.34*; D: -0.47±0.35*; and E: -0.34±0.23S-1*, *p<0.05) without elevation of E/e’ in normal geometry (9.5±2.1, 10.4±2.7, 11.0±2.3*, 13.0±4.2*, 12.5±2.9* and 15.0±5.5*, respectively). LV stiffness increased in HTN with LVH and HFpEF (0.48±0.23, 0.53±0.17, 0.53±0.24, 0.75±0.51*, 1.01±0.43* and 1.46±0.47*, respectively). PCWP in LVH and HFpEF was elevated (6.9±2.8, 7.3±2.4, 7.7±2.9, 9.8±3.9*, 12.1±3.4* and 14.5±2.8mmHg*, respectively).
Conclusions: LV relaxation assessed by global SR-IVR was impaired even in normal geometry despite no reduction in LVEF and no elevation of E/e’, and further reduced in HFpEF. LV stiffness and PCWP were increased in HTN with LVH and those were further increased in HFpEF. LV diastolic function can be noninvasively evaluated using novel one-beat 3D-STE with high volume rates (66±5 vps).
Author Disclosures: M. Kawasaki: None. M.R. Zile: None. R. Tanaka: None. S. Minatoguchi: None. T. Watanabe: None. K. Ono: None. M. Saeki: None. M. Nagaya: None. N. Sato: None. S. Warita: None. S. Tanihata: None. M. Arai: None. T. Noda: None. S. Watanabe: None. H. Sato: None. H. Houle: None. S. Minatoguchi: None.
- © 2014 by American Heart Association, Inc.