Assessment of myocardial work in high normal blood pressure and hypertension patients by echocardiographic left ventricular pressure-strain loop

doi:10.3877/cma.j.issn.1672-6448.2022.06.006

Abstract

Abstract:

Objective

To evaluate myocardial work by echocardiographic left ventricular pressure-strain loop (PSL) in patients with high normal blood pressure and hypertension.

Methods

Forty-five patients with hypertension (hypertension group) who underwent echocardiography at Beijing Chaoyang Hospital Affiliated to Capital Medical University from August 2019 to March 2020 were selected retrospectively. Forty patients with high normal blood pressure (high normal blood pressure group) and 30 subjects with normal blood pressure (normal blood pressure group) were included in the same period and received echocardiography. The parameters of conventional echocardiography were measured, and the left ventricular global longitudinal strain (GLS) and mechanical dispersion (MD) were assessed by speckle tracking echocardiography. The left ventricular PSL was used to evaluate myocardial work parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE). Echocardiographic parameters, myocardial strain parameters, and myocardial work parameters were compared among the three groups, and the correlation of myocardial work parameters with conventional echocardiographic parameters and myocardial strain parameters was analyzed.

Results

GLS decreased successively in the normal blood pressure group, high normal blood pressure group, and hypertension group, but there was no significant difference among the three groups (P＞0.05). MD was significantly higher in the hypertension group than in the normal blood pressure group and high normal blood pressure group (P＜0.05). Compared with normal blood pressure group, GWI and GCW were increased (P＜0.05) in the high normal blood pressure group. GWI, GCW, and GWW were increased, while GWE was decreased in the hypertension group (P＜0.05) compared with the normal blood pressure group. GCW and GWW were increased and GWE was decreased in the high normal blood pressure group (P＜0.05) compared with the high normal blood pressure group. In the hypertension group, GWI and GCW were positively correlated with GLS (r=0.695 and r=0.691, P＜0.001) and LVEF (r=0.409 and r=0.406, P=0.001). GWW was negatively correlated with GLS (r=-0.306, P＜0.05), and positively correlated with MD (r=0.384, P=0.002). GWE was positively correlated with GLS (r=0.519, P＜0.001), and negatively correlated with MD (r=-0.482, P＜0.001).

Conclusion

The myocardial work efficiency of patients with high normal blood pressure is still normal, while that of patients with hypertension is damaged and the energy loss is increased. Quantitative evaluation of myocardial work by left ventricular PSL may provide more valuable information for the evaluation of cardiac function in patients with high normal blood pressure and hypertension.

Key words: Echocardiography, Pressure-strain loop, Myocardial work, Hypertension

Xueyan Ding, Yidan Li, Lanlan Sun, Xiaoguang Ye, Qizhe Cai, Yunyun Qin, Yuanzhi Li, Jiangtao Wang, Xiuzhang Lyu. Assessment of myocardial work in high normal blood pressure and hypertension patients by echocardiographic left ventricular pressure-strain loop[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(06): 521-526.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2022.06.006

https://chaosheng.cma-cmc.com.cn/EN/Y2022/V19/I06/521

Figures/Tables 5

组别	例数	男/女（例）	年龄（岁）	BSA（m²）	心率（次/分）
正常血压组	30	15/15	53±13	1.71±0.15	69±10
正常高值血压组	40	21/19	52±13	1.75±0.18	68±12
高血压组	45	24/21	52±13	1.74±0.18	69±10
统计值		χ²=0.083	F=0.109	F=2.179	F=1.503
P值		0.959	0.897	0.118	0.227

组别	例数	LVEDV（ml）	LVESV（ml）	LVEF（%）	LVMI（g/m²）	E/e′
正常血压组	30	74.6±12.6	25.1±5.2	66.7±4.4	80.3±15.9	7.6±1.8
正常高值血压组	40	79.5±15.9	27.9±7.3	65.4±3.7	82.7±12.9	7.6±2.1
高血压组	45	78.8±17.5	24.9±7.7	65.4±5.0	93.9±26.3^a	8.0±2.0
F值		2.675	1.850	0.813	8.525	0.761
P值		0.196	0.162	0.446	＜0.001	0.469

组别	例数	GLS（%， $x ¯$ ±s）	MD（ms， $x ¯$ ±s）	GWI（mmHg%， $x ¯$ ±s）	GCW（mmHg%， $x ¯$ ±s）	GWW［mmHg%，M（P₂₅，P₇₅）］	GWE［mmHg%，M（P₂₅，P₇₅）］
正常血压组	30	21.2±1.7	38.9±10.6	1899.3±261.8	2084.8±247.3	79（50，111）	96（94，97）
正常高值血压组	40	20.6±1.7	39.3±9.9	2236.7±257.4 ^a	2430.1±274.6 ^a	94（65，116）	95（95，96）
高血压组	45	20.1±2.4	47.7±10.0 ^ab	2288.8±358.5 ^a	2593.4±355.3 ^ab	126.5（105.8，161.3）^ab	94（93，95）^ab
统计值		F=2.707	F=11.154	F=12.655	F=23.774	H=14.232	H=9.661
P值		0.071	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	GLS（%， $x ¯$ ±s）	MD（ms， $x ¯$ ±s）	GWI（mmHg%， $x ¯$ ±s）	GCW（mmHg%， $x ¯$ ±s）	GWW［mmHg%，M（P₂₅，P₇₅）］	GWE［mmHg%，M（P₂₅，P₇₅）］
正常血压组	30	21.2±1.7	38.9±10.6	1899.3±261.8	2084.8±247.3	79（50，111）	96（94，97）
正常高值血压组	40	20.6±1.7	39.3±9.9	2236.7±257.4 ^a	2430.1±274.6 ^a	94（65，116）	95（95，96）
高血压组	45	20.1±2.4	47.7±10.0 ^ab	2288.8±358.5 ^a	2593.4±355.3 ^ab	126.5（105.8，161.3）^ab	94（93，95）^ab
统计值		F=2.707	F=11.154	F=12.655	F=23.774	H=14.232	H=9.661
P值		0.071	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	观察者内		观察者间
组别	ICC	95% CI	ICC	95% CI
GWI组	0.93	0.84~0.97	0.90	0.82~0.96
GCW组	0.92	0.83~0.97	0.87	0.80~0.93
GWW组	0.84	0.81~0.90	0.81	0.70~0.89
GWE组	0.90	0.82~0.94	0.90	0.80~0.94

References 11

1	Kachur S, Morera R, De Schutter A, et al. Cardiovascular risk in patients with prehypertension and the metabolic syndrome[J]. Curr Hypertens Rep, 2018, 20(2): 15.
2	Hiemstra YL, van der Bijl P, El Mahdiui M, et al. Myocardial work in nonobstructive hypertrophic cardiomyopathy: implications for outcome[J]. J Am Soc Echocardiogr, 2021, 34(2): 201.
3	Manganaro R, Marchetta S, Dulgheru R, et al. Echocardiographic reference ranges for normal non-invasive myocardial work indices: results from the EACVI NORRE study[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(5): 582-590.
4	中国高血压防治指南修订委员会, 高血压联盟(中国, 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56.
5	Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging[J]. J Am Soc Echocardiogr, 2015, 28(1): 1-39.e14.
6	Edwards N, Scalia GM, Shiino K, et al. Global myocardial work is superior to global longitudinal strain to predict significant coronary artery disease in patients with normal left ventricular function and wall motion[J]. J Am Soc Echocardiogr, 2019, 32(8): 947-957.
7	Galli E, Leclercq C, Hubert A, et al. Role of myocardial constructive work in the identification of responders to CRT[J]. Eur Heart J Cardiovasc Imaging, 2018, 19(9): 1010-1018.
8	姚丙南, 仇萍, 王玉芳, 等. 分层应变技术对高血压前期患者左心室纵向收缩功能的评价[J]. 中国心血管杂志, 2017, 22(6): 418-422.
9	Chan J, Edwards N, Khandheria BK, et al. A new approach to assess myocardial work by non-invasive left ventricular pressure-strain relations in hypertension and dilated cardiomyopathy[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(1): 31-39.
10	谷春红, 魏常华, 袁建军, 等. 纵向应变及应变达峰时间离散度评价原发性高血压患者左心室纵向收缩功能的应用价值[J]. 中华超声影像学杂志, 2018, 27(6): 473-478.
11	孔令云, 高霞, 丁雪晏, 等. 二维斑点追踪成像评价甲状腺功能减退症对左心室机械形变及其异质性的影响[J]. 中华超声影像学杂志, 2018, 27(4): 282-287.

[1]	Wanwei Zhang, Yunyun Qin, Qizhe Cai, Mingming Lin, Runyu Tian, Shan Jin, Xiuzhang Lyu. Value of myocardial early systolic lengthening in non-ST-segment elevation acute coronary syndrome for predicting severe coronary artery stenosis [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1016-1022.
[2]	Shutang Ren, Xiaocheng Liu, Yadong Zhang, Jiaying Sun, Ping Chen, Jianhua Zhou, Jin Long, Yunzhou Huang. Echocardioimagedata features of solo-systolic aortic regurgitation during left ventricular assist device support [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1023-1028.
[3]	Jinmei He, Lixue Yin, Jing Tan, Wenjun Zhang, Rui Wang, Mei Ren, Mingjiao Liao. Evaluation of potential left ventricular systolic dysfunction in patients with type 2 diabetes mellitus using ultrasonic myocardial work technology [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1029-1035.
[4]	Yanling Xue, Xiaojing Ma, Shurui Xie, Jun He, Juan Xia, Yafeng He. Application value of left ventricular opacification in acute myocardial infarction with ventricular septal rupture [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1036-1039.
[5]	Xining Wu, Yunshu Ouyang, Yixiu Zhang, Hua Meng, Zhonghui Xu, Peipei Zhang, Ke Lyu. Application of fetal echocardiography in prenatal management of fetuses with positive maternal anti-SSA/Ro-SSB/La antibodies [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1056-1060.
[6]	Shuihua Yang, Guidan He, Guican Qin, Mengfeng Liang, Yanhe Luo, Xueqin Li, Juansong Tang. Echocardioimagedata characteristics of fetal isolated total anomalous pulmonary venous connection and application of high definition flow imaging and spatio-temporal image correlation [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1061-1067.
[7]	Baofu Zhang, Jin Yu, Jingjing Ye, Jiangen Yu, Xiaohui Ma, Xiwang Liu. Echocardioimagedata diagnosis of anomalous pulmonary venous connection caused by congenital malposition of the septum primum [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1074-1080.
[8]	Hongjuan Zhao, Bowen Zhao, Mei Pan, Yuanyuan Ji, Xiaohui Peng, Ran Chen. Measurement of left ventricular systolic to diastolic time index in normal fetuses in the second and third trimesters using both spectral and tissue Doppler echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 951-958.
[9]	Danni Liu, Meng Ao, Haitao Ran, Shiyu Li, Fang Qin. Biatrial structure and function reverse remodelling in patients with persistent atrial fibrillation after cardioversion: evidence from three dimensional echocardiography and two dimensional speckle tracking imaging [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 827-835.
[10]	Jiaying Sun, Yunzhou Huang, Shutang Ren, Cuihua Wang, Xinhua Chen, Aijia Yu, Yuanlu Chen. No-invasive myocardial work for evaluation of global and segmental myocardial function in patients with left bundle branch block [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 836-843.
[11]	Jingjing Zhang, Bowen Zhao, Mei Pan, Xiaohui Peng, Yankai Mao, Chenke Pan, Lingyan Zhu, Linlin Zhu, Qiuye Lan. Evaluation of fetal pulmonary development using McGoon index measured by fetal echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 860-865.
[12]	Lu Zhong, Sheng Cao, Hongning Song, Jinling Chen, Qing Zhou. Quality control of quantitative assessment of mitral regurgitation by echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 705-711.
[13]	Peng Xu, Jun Li, Weilun Gao, Zheng Wang, Shen Pang, Chunni Li, Ting Zhu. Application of fast rotary scanning method in fetal echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(07): 761-766.
[14]	Jianmei Li, Jingjuan Deng, Qian Yang. Safety and follow-up evaluation of the combined treatment of hepatocellular carcinoma with hepatic cirrhosis and portal hypertension [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 41-44.
[15]	Nianyu Xue, Shengmin Zhang, Lingheng Wu, Lei Sha, Lanyue Tong, Cuiqin Shen, Zhaojun Li, Lianfang Du. Effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 1004-1009.

Please choose a citation manager

Content to export