Evaluation of myocardial stiffness by intrinsic cardiac elastography in hypertensivepatients with different types of left ventricular remodeling

doi:10.3877/cma.j.issn.1672-6448.2021.02.002

Abstract

Abstract:

Objective

To explore the feasibility and clinical value of end-diastolic left ventricular intrinsic velocity propagation (IVP) of myocardial stretch measured by high-frame rate tissue Doppler echocardiography forevaluating myocardial stiffness in hypertensive patients with different types of left ventricular remodeling.

Methods

A total of 90 hypertensive patients with different types of left ventricular remodeling (22 patients with normal geometry, 30 with concentric remodeling, and 38 with concentric hypertrophy) and 30 healthy controls were prospectively included in this study. All subjects underwent comprehensive echocardiographic examination including speckle tracking and measurement of global longitudinal strain (GLS) of the left ventricle, and IVP of myocardial stretch,which is a direct and quantitative measurement index of myocardial elasticity. The differences of IVP among the groups were compared.The correlations between IVP and common echocardiographic parameters or GLS were analyzed. The sensitivity and specificity of IVP in predicting left ventricular concentric hypertrophy were analyzed by receiver operating characteristic (ROC) curve analysis.

Results

IVP in hypertensive patients was higher than that of healthy controls, and IVP in the concentric hypertrophy subgroup was significantly higher than that of the other two left ventricular remodeling subgroups(P<0.05). IVP was significantly positively correlated with left ventricular posterior wall thickness, left ventricular mass index, thickness of interventricular septum, relative wall thickness, systolic blood pressure, and E/e'(r=0.732, 0.695, 0.670, 0.652, 0.626, and 0.625, respectively; P<0.001 for all), and negatively correlated with GLS and e'average (r=-0.593 and -0.445, respectively). ROC curve analysis showed that IVP>179.84 cm/s was the best threshold for predicting left ventricular concentric hypertrophy in hypertensive patients (sensitivity 92%, specificity 61%). Condusion IVP is a new parameter for noninvasive and quantitative evaluation of left ventricular myocardial stiffness in hypertensive patients with left ventricular remodeling, which is worthy of further study and application.

Key words: Echocardiography, Arterial hypertension, Myocardial stiffness, Elasticity, Cardiacremodeling

Liqun Wei, Yidan Li, Xueyan Ding, Weiwei Zhu, juan Wang, Jiangtao Wang, Xiuzhang Lyu. Evaluation of myocardial stiffness by intrinsic cardiac elastography in hypertensivepatients with different types of left ventricular remodeling[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(02): 128-134.

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Figures/Tables 5

References 27

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参数	对照组(n=30)	高血压组			F/χ²值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F/χ²值	P值
年龄	55±14	55±14	60±13	59±13	1.102	0.352
男性(%)	19(63.3)	11(50.0)	19(63.3)	26(68.4)	2.053	0.562
高血压病程(年)	-	8.6±5.0	10.6±8.5	14.0±11.6	2.593^d	0.081^d
BMI(kg/m²)	23.8±3.2	27.0±4.8	29.0±7.3^a	27.0±5.8	4.423	0.006
BSA(m²)	1.75±0.12	1.91±0.16^a	1.91±0.16^a	1.93±0.28^a	5.564	0.001
HR(次/min)	74.1±13.3	79.1±16.0	70.2±10.7	74.3±12.0	2.041	0.112
SBP(mmHg)	113.0±11.2	144.6±20.2^a	146.7±19.7^a	162.7±20.7^abc	39.462	＜0.001
DBP(mmHg)	73.4±11.1	82.0±15.8	83.1±17.5	90.0±18.8^a	5.589	0.001

参数	对照组(n=30)	高血压组			F/χ²值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F/χ²值	P值
年龄	55±14	55±14	60±13	59±13	1.102	0.352
男性(%)	19(63.3)	11(50.0)	19(63.3)	26(68.4)	2.053	0.562
高血压病程(年)	-	8.6±5.0	10.6±8.5	14.0±11.6	2.593^d	0.081^d
BMI(kg/m²)	23.8±3.2	27.0±4.8	29.0±7.3^a	27.0±5.8	4.423	0.006
BSA(m²)	1.75±0.12	1.91±0.16^a	1.91±0.16^a	1.93±0.28^a	5.564	0.001
HR(次/min)	74.1±13.3	79.1±16.0	70.2±10.7	74.3±12.0	2.041	0.112
SBP(mmHg)	113.0±11.2	144.6±20.2^a	146.7±19.7^a	162.7±20.7^abc	39.462	＜0.001
DBP(mmHg)	73.4±11.1	82.0±15.8	83.1±17.5	90.0±18.8^a	5.589	0.001

参数	对照组(n=30)	高血压组			F值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F值	P值
IVS(mm)	9.4±0.9	10.5±0.9^a	12.0±1.3^ab	13.5±1.3^abc	80.882	＜0.001
PWT(mm)	9.0±0.8	9.5±0.6	11.2±1.0^ab	13.1±1.3^abc	112.868	＜0.001
LVEDD(mm)	46.4±3.2	46.7±2.2	43.5±2.9^ab	47.3±3.6^c	9.319	＜0.001
RWT	0.39±0.03	0.41±0.02	0.52±0.06^ab	0.56±0.08^abc	66.938	＜0.001
LVMI(g/m²)	83.0±13.9	85.8±11.1	94.1±8.9^a	130.2±19.1^abc	78.625	＜0.001
LVEF(%)	67.0±3.8	66.9±3.8	67.2±3.7	66.0±3.4	0.717	0.544
GLS	20.8±1.8	19.5±2.3	18.9±2.0^a	16.8±1.6^abc	25.879	＜0.001
E(cm/s)	77.2±21.8	68.5±24.3	70.5±17.7	75.9±26.3	0.928	0.429
A(cm/s)	69.9±14.8	81.7±17.5	83.4±22.4^a	79.9±19.5	3.039	0.032
e' average	10.1±2.7	8.2±2.4^a	6.7±1.5^a	6.4±1.7^ab	21.477	＜0.001
E/e'average	7.9±2.1	8.4±2.2	11.0±3.4^ab	12.3±4.2^ab	13.297	＜0.001
LAV(ml)	45.4±9.9	50.1±13.2	60.9±16.7^a	75.7±25.1^abc	18.22	＜0.001
LAVI(ml/m²)	25.9±5.4	26.4±7.3	31.7±8.0	39.5±13.4^abc	14.499	＜0.001
IVP(cm/s)	132.1±21.0	156.1±28.0	173.9±31.2^a	224.1±41.7^abc	49.176	＜0.001

参数	对照组(n=30)	高血压组			F值	P值
参数	对照组(n=30)	NG组(n=22)	CR组(n=30)	CH组(n=38)	F值	P值
IVS(mm)	9.4±0.9	10.5±0.9^a	12.0±1.3^ab	13.5±1.3^abc	80.882	＜0.001
PWT(mm)	9.0±0.8	9.5±0.6	11.2±1.0^ab	13.1±1.3^abc	112.868	＜0.001
LVEDD(mm)	46.4±3.2	46.7±2.2	43.5±2.9^ab	47.3±3.6^c	9.319	＜0.001
RWT	0.39±0.03	0.41±0.02	0.52±0.06^ab	0.56±0.08^abc	66.938	＜0.001
LVMI(g/m²)	83.0±13.9	85.8±11.1	94.1±8.9^a	130.2±19.1^abc	78.625	＜0.001
LVEF(%)	67.0±3.8	66.9±3.8	67.2±3.7	66.0±3.4	0.717	0.544
GLS	20.8±1.8	19.5±2.3	18.9±2.0^a	16.8±1.6^abc	25.879	＜0.001
E(cm/s)	77.2±21.8	68.5±24.3	70.5±17.7	75.9±26.3	0.928	0.429
A(cm/s)	69.9±14.8	81.7±17.5	83.4±22.4^a	79.9±19.5	3.039	0.032
e' average	10.1±2.7	8.2±2.4^a	6.7±1.5^a	6.4±1.7^ab	21.477	＜0.001
E/e'average	7.9±2.1	8.4±2.2	11.0±3.4^ab	12.3±4.2^ab	13.297	＜0.001
LAV(ml)	45.4±9.9	50.1±13.2	60.9±16.7^a	75.7±25.1^abc	18.22	＜0.001
LAVI(ml/m²)	25.9±5.4	26.4±7.3	31.7±8.0	39.5±13.4^abc	14.499	＜0.001
IVP(cm/s)	132.1±21.0	156.1±28.0	173.9±31.2^a	224.1±41.7^abc	49.176	＜0.001

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