Key result
The novel echocardiographic product of interventricular septal thickness and aortic acceleration-to-ejection time ratio (IVSd x AT/ET) ≥2.7 mm was the best predictor of impaired global longitudinal strain.
Why the study?
Two-dimensional speckle-tracking echocardiography (STE) detects subclinical LV systolic dysfunction in hypertensive patients with preserved LVEF, but is underutilized or unavailable locally due to financial and technical reasons.
What are the clinical and conventional echocardiographic predictors of impaired global longitudinal strain in patients with essential hypertension and preserved ejection fraction?
Cross-Sectional (n=100)
No
What are the clinical and conventional echocardiographic predictors of impaired global longitudinal strain in patients with essential hypertension and preserved ejection fraction?
Effect estimate: AU ROC 0.8 (95% CI 0.68-0.93)
p-value: p=0.001
In hypertensive patients with preserved ejection fraction, conventional echocardiographic parameters, particularly the novel product of IVSd x AT/ET, can reliably predict impaired global longitudinal strain, aiding risk stratification when speckle-tracking is unavailable.
Background: Early identification of hypertensive patients at risk of heart failure (HF) helps guide treatment intensification and predict prognosis. Global longitudinal strain (GLS) derived from two-dimensional speckle-tracking echocardiography (STE) uncovers subclinical left ventricular (LV) systolic dysfunction (SLVSD) in patients with hypertension (HT) and preserved LV ejection fraction (PLVEF). STE is unavailable and/or underutilized in our locality for financial and technical reasons. Objectives: We aim to identify clinical and echocardiographic parameters associated with and/or predictive of impaired GLS in hypertensive patients with PLVEF. Method: In this single-clinic, cross-sectional, observational study, 100 hypertensive patients with PLVEF were examined using conventional and 2D STE. Results: The average GLS was found to be mildly reduced (-18.4 ± 2.2%) in the study group. Lower GLS (than -19%) was more common among patients with poorly controlled HT (Odds Ratio (OR)=9), being on multiple anti-hypertensive agents (OR=5), positive Sokolow-Lyon electrocardiographic criteria (OR=4.3), and obesity (OR=2). Conventional echocardiographic parameters predicting impaired GLS included: mitral annular plane systolic excursion (MAPSE) (p=0.001), inter-ventricular septal thickness (IVSd) (p=0.003), LV mass (p=0.003), and LV remodelling (p=0.02). The aortic acceleration-to-ejection time ratio (AT/ET) had a good correlation with GLS (p=0.034). The novel product (IVSd x AT/ET) ≥2.7 mm was found to be the best predictor of GLS worse than -19% (AU ROC=0.8, 95% CI [0.68-0.93]; p=0.001). Conclusion: In hypertensive patients with PLVEF, GLS was found to correlate well with blood pressure (BP) control, body size, measures of LV mass, and MAPSE. These parameters predict at least 50% of the variance in GLS and could help practitioners with limited access to STE in risk-stratifying hypertensive patients.
No takes yet. Share an insight, caveat, or question.
Noori et al. (2022) conducted a cross-sectional in Essential hypertension with preserved ejection fraction (n=100). IVSd x AT/ET ≥2.7 mm vs. IVSd x AT/ET <2.7 mm was evaluated on Global longitudinal strain (GLS) worse than -19% (AU ROC 0.8, 95% CI 0.68-0.93, p=0.001). The novel echocardiographic product of interventricular septal thickness and aortic acceleration-to-ejection time ratio (IVSd x AT/ET) ≥2.7 mm was the best predictor of impaired global longitudinal strain.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: