Abstract 9367: Speckle-Tracking and Tissue-Doppler Stress Echocardiography in Arterial Hypertension

Abstract

OBJECTIVE: 2D-strain (2DS) and tissue-Doppler imaging (TDI) was combined with physical stress echocardiography to assess differences in LV function between hypertensive patients and healthy controls under physical exercise. We hypothesized whether LV peak strain is an early marker to identify hypertensive patients at high risk for congestive heart failure. METHODS: Individuals with isolated arterial hypertension (n=30) who had no other cardiac or non-cardiac diseases were compared with a random collection of completely healthy controls (n=30). LV function was assessed with 2DS and TDI: At rest, low (50 Watts) and high resistance (150 Watts) of physical challenge on a bicycle. Global longitudinal (LS), circumferential (CS) and radial strain (RS) were assessed. Subsequently, intra- and inter-observer reliability analyses were performed (Bland-Altmann test) RESULTS: Compared to the hypertensive group (mean blood pressure (MBP) = 79.1 ± 13.6 mmHg), healthy volunteers (MBP = 84.5 ± 15 mmHg) were shown to have significantly higher values of CS (p=0.027) and LS (p=0.036) using 2DS at rest. At 50 Watts of resistance the same differences could be shown with a higher degree of statistical significance. At 150 Watts of resistance the control group (MBP = 119.9 ± 16.8 mmHg) had significantly higher levels of contractility in CS (p=0.023), LS (p=0.000) and RS (p=0.005) than hypertensive patients (MBP = 125.7 ± 15.1 mmHg). TDI showed similar results, while significant differences could only be proven at the highest level of physical challenge. The influence of physical challenge on cardiac strain was shown most distinctively by TDI in LS (p=0.000) and CS (p=0.007) in the control group. CONCLUSIONS: Compared to the healthy control group, patients with arterial hypertension were found to have reduced levels of left ventricular contractility. This promotes peak strain as an early parameter for LV deterioration due to arterial hypertension. In the assessment of the impact of hypertensive heart disease on LV contractility, 2DS was shown to be more sensitive for strain analysis at rest whereas TDI detected more differences in contractility under physical exercise. Given these results, quantitative deformation imaging is a promising addition to stress echocardiography.