Prognosis values of 3D strain in untreated hypertension

Background Three-dimentional (3D) speckle tracking echocardiography derived strain had been studied in cancer treatment with significant prognostic values. Hypertension causes deterioration of left ventricular strain. However, the prognostic effects of 3D strain have never been studied. Methods Ninety-two participants with untreated hypertension were recruited from a hypertensive clinic. All of the participants had received comprehensive assessment and echocardiography examination including 3D echocardiography. Four of them were excluded due to inadequate 3D images. 3D full volume images from the apical view were analyzed by a software. 3D left ventricular ejection fraction (3DEF), global longitudinal strain (GLS3D), global area strain (GAS3D), global circumferential strain (GCS3D), and global radial strain (GRS3D) were obtained. After initial evaluation, participants were regularly treated and followed in the same clinic. The study end-points were heart failure admission, coronary artery disease included acute coronary syndrome and coronary revascularization, stroke, death, and renal failure included doubling creatinine or progression to stage 3 or above renal dysfunction. Results Eighty-eight participants (mean age 52.1 ± 12.0 years, 50 (56.8 %) men) were enrolled in this study. After a mean follow-up of 58.8 ± 28.3 months, there were 15 participants (17 %) had events, included 4 heart failure, 4 coronary disease, 1 death, 1 stroke, and 5 renal failure. Compared between participants with and without events, there were more men (26 vs. 5 %, p = 0.011), lower eGFR (79.8 ± 14.7 vs. 86.5 ± 7.2 ml/min/1.73m2, p = 0.011), higher left ventricular mass index (LVMI) (99.4 ± 43.0 vs. 70.1 ± 27.6 g/m2, p = 0.001), higher E to e’ ratio (E/e’) (9.2 ± 3.5 vs. 7.6 ± 1.9, p = 0.017), lower 3DEF (57.7 ± 8.7 vs. 63.3 ± 5.5 %, p = 0.027), poor GLS3D (-6.4 ± 3.0 vs. -9.9 ± 3.7 %, p = 0.001), poor GAS3D (-12.9 ± 5.1 vs. -19.6 ± 5.8 %, P <0.001), poor GCS3D (-8.0 ± 3.5 vs. -12.3 ± 3.7 %, p <0.001), and poor GRS3D (17.5 ± 7.3 vs. 30.0 ± 10.2 %, p <0.001) in participants with events. Multi-variate COX regression analysis controlling gender, eGFR, LVMI, E/e’, and 3DEF showed GAS3D (RR 1.203, 95% CI 1.058-1.368, p = 0.005), GCS3D (RR 1.414, 95% CI 1.129-1.771, p = 0.003), and GRS3D (RR 0.888, 95% CI 0.813-0.970, p = 0.009) were independent prognostic factors but not GLS3D. Kaplan-Meire curve demonstrated significant separation of cumulated survival curve between high and low strain (Figure). Conclusions Our study showed 3D strain parameters including GAS3D, GCS3D, GRS3D had prognostic values in untreated hypertension patients after 6 years of follow-up. 3D strain is useful in assessment of hypertensive heart disease.