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European Journal of Echocardiography Advance Access originally published online on October 2, 2007
European Journal of Echocardiography 2008 9(4):501-508; doi:10.1016/j.euje.2007.08.004
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Regional left ventricular deformation and geometry analysis provides insights in myocardial remodelling in mild to moderate hypertension

Aigul Baltabaeva1, Maciej Marciniak2, Bart Bijnens1,3, James Moggridge1, Feng J. He2, Tarek F. Antonios2, Graham A. MacGregor2 and George R. Sutherland1,*

1 Department of Cardiology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK
2 Blood Pressure Unit, Department of Cardiac and Vascular Sciences, St George's University of London, UK
3 University of Leuven, Belgium

Received 20 February 2007; accepted after revision 15 August 2007; online publish-ahead-of-print 2 October 2007.

* Corresponding author. Tel: +44 20 8725 1397; fax: +44 20 8725 4402. E-mail address: george.sutherland{at}stgeorges.nhs.uk (G.R. Sutherland).


  Abstract

Aim: In the early stages of hypertension (HTN), when global left ventricular (LV) function is still unaffected, localized geometrical changes suggest changes in regional function. We investigated regional geometry and systolic deformation (using strain/strain rate (S/SR) imaging) in HTN.

Methods and results: We studied 74 untreated mild to moderate HTNs and 34 matched normotensives (NTN). All had a standard echo including myocardial velocity data for regional radial and longitudinal deformation. Despite the absence of abnormalities in standard functional indices and LVH, non-uniform changes in regional geometry and deformation were observed. Besides a significant increase in wall thickness (WT) in all HTN segments, there was a gradual increase in WT from apex to base resulting in prominent basal septal hypertrophy. In HTN, regional longitudinal peak systolic SR (SSR) and end-systolic S (ESS) were significantly (P < 0.0001) reduced in the basal septum. In the lateral wall there was an increase in peak SSR and ESS (P < 0.05) basally. The basal septal ESS correlated both with mean arterial pressure and basal septal WT, with lower ESS for higher BP and thicker septum.

Conclusion: Regionally differing geometrical remodelling occurs early in HTN. Longitudinal ESS and peak SSR are sensitive markers of early changes occurring in HTN.

Keywords: Hypertension; Hypertrophy; Echocardiography; Remodelling; Strain imaging


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