Why the study?
High LV mass/end-diastolic volume ratio is linked to LV dysfunction and myocardial fibrosis in hypertension, but its ability to identify early systolic and diastolic dysfunction via 3D echocardiography was unclear.
Does an elevated 3D-LVM/EDV ratio identify early systolic and diastolic dysfunction in newly diagnosed, never-treated hypertensive patients?
Does an elevated 3D-LVM/EDV ratio identify early systolic and diastolic dysfunction in newly diagnosed, never-treated hypertensive patients?
Three-dimensional echocardiographic assessment of LV concentric geometry via LVM/EDV ratio independently identifies early diastolic and longitudinal systolic dysfunction in native hypertensive patients.
3D-echo LVM/EDV may flag early LV dysfunction in untreated hypertension; leaves open incremental value for risk stratification.
BACKGROUND: In hypertensive patients, high left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) is related to LV dysfunction and myocardial fibrosis. PURPOSE: We examined the ability of 3D-echo-derived LVM/EDV ratio in identifying early systolic and diastolic dysfunction in relation with LV concentric geometry in native hypertensive patients. METHODS: One-hundred and forty-four newly diagnosed, never treated hypertensive patients underwent 2D-echo, including computation of 2D-derived global longitudinal strain (GLS), and 3D-echo. The study population was divided into two groups: elevated 3D-LVM/EDV (≥1.23 in women and ≥1.22 in men), corresponding to LV concentric geometry (n = 50), and normal ratio (<1.23 in women and <1.22 in men) corresponding to LV normal or eccentric geometry (n = 94). RESULTS: The two groups were comparable for sex, heart rate, BMI, and blood pressure (BP). Patients with elevated 3D-LVM/EDV ratio were older and had lower GLS (P < 0.001) than patients with normal LVM/EDV ratio. Transmitral E/A ratio (P < 0.0001) and e' velocity (P < 0.0001) were lower, and E/e' ratio (P < 0.0001) higher in patients with elevated LVM/EDV ratio. In the pooled population, LVM/EDV ratio was positively correlated to E/e' (r = 0.39, P < 0.0001) and negatively to GLS (r = -0.29, P < 0.001). By separate multilinear regression analyses, after adjusting for sex, age, heart rate, mean BP and BMI, LVM/EDV ratio - but not 2D-relative wall thickness - was independently associated with E/e' (β = 0.304, P = 0.003) and GLS (β = -0.501, P < 0.0001). CONCLUSION: Three-dimensional echocardiographic assessment of LV concentric geometry allows identifying an early diastolic and longitudinal systolic dysfunction in native hypertensive patients. In particular, 3D-LVM/EDV ratio is independently associated with both E/e' ratio and GLS.
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Lembo et al. (2019) studied this question.
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