Abstract 11979: Noninvasive Evaluation of the Feature of Hypertensive Heart Failure using One-beat Real-time Three-dimensional Speckle Tracking Echocardiography With High Volume Rates
Background: Left ventricular (LV) properties in hypertension (HTN) could be deteriorated by pressure overload that causes LV hypertrophy (LVH) resulting in hypertensive heart failure (HHF). However, transition from HTN to HHF and the feature of HHF have not been noninvasively examined.
Methods: We examined 31 controls (age 69±9), 47 HTN without LVH: LVH (-) (age 70±9), 47 HTN with LVH: LVH (+) (age 69±6) and 37 HHF patients (age 71±11) by 3-dimensional speckle tracking echocardiography with volume rate of 70-80vps (3D-STE). LV contractility and relaxation were assessed by radial strain rate (SR) at systole (SR-S) and isovolumic relaxation (SR-IVR). LV torsion was measured by 3D-STE. Pulmonary capillary wedge pressure (PCWP) was calculated as 10.8 - 12.4 x log (left atrial active emptying function / left atrial minimum volume index) as we reported. Tau was estimated as isovolumic relaxation time / (ln 0.9 x systolic blood pressure - ln PCWP). LV stress was calculated as LV radius x pressure / thickness. LV stiffness was estimated as diastolic stress / strain.
Results: LV SR-S and SR-IVR in HHF decreased (SR-S; control: 2.5±0.8, LVH (-): 2.6±0.6, LVH (+): 2.5±0.7, HHF: 1.9±0.4* s-1. SR-IVR; -0.8±0.5, -0.7±0.4, -0.7±0.4*, -0.5±0.4* s-1, *p<0.05 vs control). LV ejection fraction (EF) in HHF decreased (66±9, 69±6, 67±11, 51±14* %) associated with reduced torsion (1.4±0.2, 1.4±0.3, 1.5±0.3, 1.2±0.2* °/cm) and increased systolic stress. Tau was prolonged even in LVH (-) (29±12, 41±14*, 47±14*, 65±19*, msec). LV stiffness increased in LVH (+) and HHF (0.5±0.2, 0.6±0.4, 0.6±0.3*, 1.5±1.2*) associated with elevated PCWP (7±2, 8±4, 9±4*, 15±5* mmHg) and diastolic stress (16±5, 19±12, 21±12, 32±13* dynes/cm2). On multivariate logistic analysis, ePCWP was the parameter that showed the strongest independent factor associated with HHF. Using 11mmHg as a cutoff value, sensitivity and specificity to predict HHF in the HTN group was 83 and 81%.
Conclusion: Noninvasive 3D-STE examination revealed that LV contractility and relaxation were decreased in HHF and that HHF had more reduced EF, prolonged Tau and increased stiffness associated with reduced torsion, increased systolic and diastolic stress and PCWP. PCWP was an independent determinant of HHF in echo parameters.
Author Disclosures: M. Kawasaki: None. R. Tanaka: None. S. Minatoguchi: None. H. Sato: None. K. Nagata: None. S. Sawada: None. M. Ishiguro: None. T. Yoshizane: None. Y. Goto: None. M. Iwama: None. T. Hirose: None. K. Ono: None. M. Arai: None. T. Noda: None. S. Watanabe: None. S. Minatoguchi: None.
- © 2015 by American Heart Association, Inc.