Apical Sparing Strain Imaging In Patients With Hypertensive Emergency: A Study Of Patients Characteristics And Prognostic Value

Abstract

<h3>Objective</h3> What are the clinical characteristics and prognostic values of patients with apical sparing strains compared to those with a normal strain pattern in hypertensive emergency? <h3>Background</h3> Differences in strain values among segments on the standard bull's eye model can give clues to different disease patterns. A pattern of apical sparing (AS) has been associated with cardiac amyloidosis, hypertrophic cardiomyopathy, hypertension, and aortic stenosis. Changes in longitudinal strain predict subsequent development of heart failure or reduction in left ventricular ejection fraction in patients undergoing cardiotoxic chemotherapy. <h3>Methods</h3> We conducted a historical cohort study of all patients with an admission diagnosis of hypertensive emergency who had an echocardiogram done with evaluation of the strain pattern. Patients with AS were compared to those without AS on the following characteristics: demographics (age, race, sex), comorbidities as measured by the Charlson Weighted Index of Comorbidity (CWIC), ejection fraction and laboratory values including creatinine and hemoglobin levels on admission, pro-BNP (if available), discharge disposition and readmission within 30 days. Patients were followed in time (via medical records) from the initial admission to collect any other ejection fraction data on echocardiogram that were in the medical records. <h3>Results</h3> There were 946 unique patients admitted with a diagnosis of hypertensive urgency or emergency. A total of 120 patients had an evaluation of the strain pattern on the echocardiogram. Approximately one-third [n=35] of patients admitted to the hospital with hypertensive emergency had apical sparing strain versus two-third [n=85] has non-apical sparing (figure 1). Forty percent and sixty percent of AS patients were males and females respectively, whereas, 55% and 45% of non-AS patients were males and females respectively. The mean age at admission was 58.2 ± 14.7 in AS and 60.6 ± 14.3 in non-apical sparing patients. A 97.1% of AS and 85.9% of non-AS patients were black p = 0.071. The mean baseline ejection fraction (EF) was 48.89% ± 12.55 and follow-up EF was 50.83% ± 12.63 in the apical sparing group p=0.58. On the other hand, the mean baseline EF was 53.47% ± 13.92, and follow-up EF% was 54.72% ± 14.83 in the non-apical sparing group p=0.39. The readmission rate within 30 days from discharge was 17.1% in AS versus 21.2% non-AS group. <h3>Conclusion</h3> The data showed a higher prevalence of AS strains in black patients and female patients. Patients with AS were younger than those without AS. The baseline and follow-up ejection fraction were similar in both study groups. Almost one-third of patients admitted to the hospital with hypertensive emergency/urgency have an apical sparing pattern. To summarize, the apical sparing pattern is not exclusive to cardiac amyloidosis and it is more commonly seen in hypertensive heart disease.