European Journal of Echocardiography Advance Access originally published online on December 24, 2008
European Journal of Echocardiography 2009 10(4):519-526; doi:10.1093/ejechocard/jen324
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Pulse pressure/stroke volume: a surrogate index of arterial stiffness and the relation to segmental relaxation and longitudinal systolic deformation in hypertensive disease
Department of Cardiology, Imperial College of Medicine and Technology, National Heart and Lung Institute (NHLI), Hammersmith Hospital, Du Cane Road, W12 0HS London, UK
Received 8 June 2008; accepted after revision 30 November 2008; online publish-ahead-of-print 24 December 2008.
* Corresponding author. Tel: +44 208 743 0121; fax: +44 208 383 4392. E-mail address: drpavlo{at}yahoo.com
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Abstract |
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Aims: Pulse pressure/stroke volume (PP/SV) is regarded as a surrogate index of arterial stiffness (AS). Strain echocardiography is a novel method to evaluate systolic and diastolic left ventricular (LV) function. The aim of this study was to investigate the effect of AS on segmental relaxation and systolic deformation in hypertensive disease.
Methods and results: We evaluated 70 hypertensive patients and 30 non-hypertensive volunteers. The patients were divided as follows: without global diastolic dysfunction (HTN-N) and with global diastolic dysfunction (HTN-DD). The segmental and global longitudinal strain (S) and strain rate (SR) and early and late diastolic SR were recorded from 18 segments. The number of segments with abnormal relaxation (SRE/SRA < 1.1) was calculated as segmental DD. Pulse pressure/SV index was used as a surrogate marker of AS. Arterial stiffness was higher in HTN-N and was more pronounced in the HTN-DD group compared with the control (1.45 ± 0.38 vs. 1.79 ± 0.36 vs.1.21 ± 0.31 mmHg m2/ml, all P < 0.05). HTN-N had increased segmental DD compared to control despite the normal conventional indices of diastolic dysfunction. Global longitudinal deformation of the HTN-N group was similar to the control; HTN-DD also showed evidence of LV hypertrophy (LVH) and had more extensive segmental DD and deteriorated global systolic deformation compared with the control, despite the normal ejection fraction (segmental DD: 11 ± 3 vs. 4 ± 2, P < 0.05 and strain: 17.7 ± 2.8 vs. 21.2 ± 2.3%, P < 0.05). The deterioration of AS in the hypertensive group was accompanied with a particular distribution of segmental DD that was more pronounced at the basal regions compared with apical LV territories. Arterial stiffness and LV mass index are found to be independent predictors of segmental DD, mean Ea, and global systolic deformation.
Conclusion: Arterial stiffness and LVH are independently related to abnormal segmental relaxation and global longitudinal systolic deformation in hypertensive disease.
Keywords: Arterial stiffness; Hypertrophy; Diastolic dysfunction; Strain