Abnormal segmental relaxation patterns in hypertensive disease and symptomatic diastolic dysfunction detected by strain echocardiography.
BACKGROUND
An abnormal segmental relaxation pattern exists as an early sign of diastolic dysfunction (DD), detectable by strain (S) echocardiography.


OBJECTIVE
The objective of this study was to investigate the relation of segmental relaxation patterns with longitudinal systolic function and symptomatic DD in patients with hypertension (HTN).


METHODS
We evaluated 30 healthy volunteers and 78 volunteers with HTN, divided as follows: (1) patients without DD (n: 28); (2) patients with asymptomatic DD (n: 25); and (3) patients with symptomatic DD (n: 25). All groups had normal ejection fraction greater than or equal to 55%. The symptomatic group had mild exertional dyspnea. All participants underwent 2-dimensional and color Doppler myocardial imaging, and the mean longitudinal strain (S) and S rate (SR) were estimated. Early and late diastolic SR parameters (SR(E) and SR(A)) were also recorded from the basal, mid, and apical segments for each wall. Altered segmental relaxation (SR(E)/SR(A) < 1.1) was regarded as an index of segmental DD.


RESULTS
Patients who were symptomatic with DD were found to have more segments with an abnormal relaxation pattern (segmental DD) and more deteriorated longitudinal systolic function based on S and SR, compared with patients with asymptomatic HTN and control subjects. Segmental DD was correlated with structural changes of left ventricular (LV) remodeling such as wall thickness (r: 0.64), relative wall thickness (r: 0.58), and LV mass index (r: 0.59), as well as mean S (r: -0.61), SR (r: -0.62), systolic blood pressure (r: 0.44), age (r: 0.49), and filling pressures (r: 0.50), all P less than .01. In multiple regression analysis, segmental DD and systolic blood pressure were independently related to symptomatic status (segmental DD: beta = 0.33, P = .003; systolic blood pressure: beta = 0.24, P = .009, R(2): 0.33). Compared with conventional indices of DD (deceleration time of the E wave, isovolumic relaxation time, E, A, and E/A), segmental DD was the only parameter that predicted symptomatic status (coefficient: 0.3817, SE: 0.1101, P = .0005, odds ratio: 1.4648, 95% confidence interval: 1.1761-1.7485).


CONCLUSIONS
LV segmental relaxation demonstrates progressive deterioration in HTN disease, which is more pronounced in patients with symptomatic DD. Altered segmental relaxation is related to structural changes of LV remodeling and constitutes an independent predictor for the presence of a symptomatic status.
Pavlopoulos
Harry
H
Hammersmith Hospital, Cardiology Department, Imperial College of Medicine and Technology, London, United Kingdom. drpavlo@yahoo.com
Nihoyannopoulos
Petros
P
D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*