Abstract 17744: Impact of Hypertensive Crisis on Left Ventricular Systolic and Diastolic Function: Comprehensive Speckle Tracking Strain Analysis vs. Conventional Echocardiography

Abstract

Introduction: Echocardiographic strain analysis using speckle tracking is more sensitive than traditional 2-D & Doppler evaluation. The acute impact of hypertensive crisis on LV systolic and diastolic function using echocardiography is not described. Hypothesis: Hypertensive crisis induces acute impairment of LV systolic & diastolic function that may be detected using strain analysis. Methods: Thirty consecutive patients with hypertensive crisis underwent serial echocardiograms including 2D, Doppler & Speckle Tracking strain analyses at baseline & after blood pressure optimization. Results: Mean age of the patients was 53.9 ± 12.8 yrs. Most common presenting symptoms were shortness of breath (70%), chest pain (43.3%), & altered mental status (13.3%). Mean systolic & diastolic blood pressures at baseline were 193.5 ± 25.1mmHg and 106.8 ± 19.8mmHg that reduced to 142.8 ± 20.5mmHg (p<0.001) and 76.7 ± 18.4mmHg (p<0.001) respectively after therapy.Baseline and follow-up echocardiograms showed reduction in left and right atrial volumes at follow-up. There was no change in LV ejection fraction & fractional shortening at follow-up (48.5 ± 18.2 % vs. 46.7 ± 18.3 %; p=0.50 and 28.0 ± 15.2 % vs. 30.8 ± 14.4 %; p=0.22 respectively). Doppler trans-mitral E-wave and A-wave velocities & mitral E/A ratio were similar at baseline and follow-up.There was an increase in mean global longitudinal LV systolic strain (-10.4 ± 4.4 % to -12.1 ± 4.2 %; p=0.011). Peak systolic circumferential strain increased on follow-up from -6.0 ± 3.2 to -11.3 ± 5.4, p=0.03.Mean global early diastolic strain increased from -4.9 ± 2.7 to -9.4 ± 5.0, p=0.05 at follow-up. Conclusions: Our study describes the impact of hypertensive crisis on echocardipgrahic parameters of LV systolic and diastolic function using strain analysis that has never been described before. Global longitudinal & circumferential systolic strain are more sensitive at detecting subtle changes in LV systolic function in the setting of hypertensive crisis when compared to ejection fraction and fractional shortening. Echocardiographic indices of LV diastolic function (E/e', Left atrial volume and mitral DT) as well as early diastolic strain also significantly improve after therapy.