J Cardiovasc Ultrasound.  2012 Jun;20(2):90-96. 10.4250/jcu.2012.20.2.90.

Impact of Arterial Stiffness on Regional Myocardial Function Assessed by Speckle Tracking Echocardiography in Patients with Hypertension

• Hwang JW
• Kang SJ
• Lim HS
• Choi BJ
• Choi SY
• Hwang GS
• Yoon MH
• Shin JH
• Tahk SJ

• KMID: 2177372
• DOI: http://doi.org/10.4250/jcu.2012.20.2.90

Abstract

BACKGROUND
Arterial stiffening may affect regional myocardial function in hypertensive patients with normal ejection fraction (EF).
METHODS
Brachial-ankle pulse wave velocity (PWV) was measured in 70 patients, of mean age 48 +/- 14 years, with untreated hypertension and EF > 55%. Using two-dimensional-speckle tracking echocardiography, we measured longitudinal and circumferential strain (epsilon) and strain rate (SR). Basal and apical rotations were measured using short axis views.
RESULTS
The mean systolic and diastolic blood pressure in these patients was 152 +/- 15 mmHg and 92 +/- 11 mmHg, respectively. The mean value of PWV was 1578 +/- 274 cm/s. PWV significantly correlated with age (r = 0.682, p < 0.001), body mass index (r = -0.330, p = 0.005), systolic blood pressure (r = 0.386, p = 0.001) and pulse pressure (r = 0.509, p < 0.001). PWV also significantly correlated with septal E' velocity (r = -0.570, p < 0.001), E/A ratio (r = -0.414, p < 0.001), E/E' ratio (r = 0.589, p < 0.001), systolic global longitudinal epsilon (r = 0.300, p = 0.012) and early diastolic SR (SRE) (r = -0.479, p < 0.001) suggesting impaired abnormal relaxation. PWV was also correlated with basal rotation (r = -0.301, p = 0.011) and basal-to-apical twist (r = -0.256, p = 0.032). The increases in apical rotation and basal-to-apical twist were attenuated in patients with PWV > 1700 cm/s compared to those with PWV < or = 1400 cm/s or those with PWV 1400-1700 cm/s.
CONCLUSION
In hypertensive patients with normal ejection fraction, arterial stiffening contributes to impaired systolic and diastolic function of the regional myocardium. Compensatory increases in ventricular twist were diminished in patients with advanced stage of vascular stiffening.

Keyword

Arterial stiffening; Regional myocardial function; Speckle tracking echocardiography

MeSH Terms

Axis, Cervical Vertebra
Blood Pressure
Body Mass Index
Echocardiography
Humans
Hypertension
Myocardium
Pulse Wave Analysis
Relaxation
Sprains and Strains
Track and Field
Vascular Stiffness

Figure

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  Fig. 1 Linear correlation of brachial-ankle pulse wave velocity with (A) the tissue Doppler parameter and (B) longitudinal peak systolic strain, and longitudinal early diastolic strain rate. PWV: brachial-ankle pulse wave velocity, E': early diastolic annulus velocity.

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  Fig. 2 Relationship between brachial-ankle pulse wave velocity and left ventricular rotation, and twist. A: Linear correlation of brachial-ankle pulse wave velocity with left ventricular rotation and twist. B: Changes in apical rotation and basal to apical twist in patients with brachial-ankle pulse wave velocity over 1700 cm/s. C: The changes of basal rotation, apical rotation, and basal to apical twist in 3 groups of brachial-ankle pulse wave velocity. PWV: brachial-ankle pulse wave velocity.

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