MYOCARDIAL STIFFNESS AND LEFT VENTRICULAR HYPERTROPHY IN THE MIDDLE-AGED HYPERTENSIVE PATIENTS

Abstract

Objective: to investigate left ventricular (LV) and left atrial (LA) stiffness parameters in middle-aged patients with grade 1–2 essentiial arterial hypertension (EAH) without concomitant cardiovascular diseases according to the presence of LV hypertrophy (LVH). Design and method: Case-control study. We examined 127 naive patients with uncomplicated grade 1–2 EAH and divided them into two groups according to the LV mass index (LVMI). The first one is included 96 hypertensive patients (HP) with LVH (mean LVMI 125,8 ± 2,1 g/m2, mean age 52,6 ± 0,7 years; mean office blood pressure (BP) 151,9 ± 1,5/93,8 ± 1,1 mm Hg). The second group consisted of 31 patients without LVH (mean LVMI 89,7 ± 2,1 g/m2, mean age 51,3 ± 1,0 years; mean office BP 138,7 ± 2,1/83,5 ± 1,9 mm Hg). 44 healthy individuals (mean age 51,5 ± 1,0 years; mean office BP 120,1 ± 2,0/80,5 ± 1,0 mm Hg) represented the control group. All the patients underwent 24-hours ambulatory BP monitoring. Comprehensive transthoracic echocardiography using Vivid 7 Dimension system (GE) was also performed. LV end-diastolic stiffness, LV end-systolic elastance, LV diastolic elastance, LA stiffness index, LA expansion index and tissue Doppler-derived (TDD) LA strain were calculated. 2-D speckle tracking echocardiography data were acquired for determination of LV myocardial global longitudinal peak strain (LV GLPS). Results: TDD LA strain was significantly higher in HP without LVH (60,01 ± 4,77%) compared to HP with LVH (49,77 ± 1,49%; p < 0,05). LV GLPS was significantly lower in absolute value in HP with LVH (−16,9 ± 0,3%) and HP without LVH (−17,5 ± 0,6%) compared to controls (−19,9 ± 0,4%; p < 0,001 and p < 0,01, respectively). No significant differences between studied groups were obtained in other myocardial stiffness parameters. LV GLPS showed a weak but significant associations with office diastolic BP (r = 0,354; p < 0,01), 24 h systolic BP (r = 0,291; p < 0,05), 24 h pulse pressure (r = 0,296; p < 0,05), and average night-time systolic and diastolic BP (r = 0,343; p < 0,01 and r = 0,262; p < 0,05, respectively). Conclusions: the present study reveals that disturbances in myocardial stiffness parameters occur early, before the development of echocardiographic signs of LHV. They are earlier markers of target organ damage even in middle-aged untreated patients with grade 1–2 uncomplicated EAH.