Two-dimensional Echocardiographic Examination Research Articles

Detection of coronary arterial lesions by two dimensional echocardiography in patients with Kawasaki disease.

A two-dimensional echocardiographic examination was conducted on 184 patients with Kawasaki disease iteratively from the acute phase to the convalescent phase. Aneurysms or dilatation of the coronary arteries were observed in 37 patients (20.1%). Among these 37 patients, 22 had persistent abnormality even after eight weeks from the onset. In the remaining 15 patients, abnormal findings disappeared within eight weeks. Coronary angiography was performed on all of these 37 patients and compared with the findings of echocardiography. In consequence, echocardiographic findings were concordant with those of the angiography in 35 patients. Therefore, the two-dimensional echocardiographic examination is thought to be a reliable noninvasive method for evaluating the coronary arterial lesions of Kawasaki disease in the acute phase.

The relationship between epicardial fat tissue thickness and red blood cell distribution width in patients with Type 2 diabetes mellitus

Aim: Red blood cell distribution width (RDW) and epicardial fat tissue (EFT) are considered as a novel risk factor for cardiovascular disease. However, their relationship in patients with type II diabetes mellitus (DM) has never investigated before. Materials and Methods: Our study was a single-center prospective study which included 159 diabetic patients and 153 healthy controls. Two-dimensional and M-mode echocardiographic examination was performed using standard apical, parasternal, and subcostal views in all the study participants. Results: EFT thickness and RDW were found to be significantly higher in diabetic patients compared to controls (4.3 ± 1.1 mm vs. 3.7 ± 1.0 mm P = 0.001 and 13.5 ± 0.7 vs. 13.2 ± 0.9 P = 0.044, respectively). EFT thickness and RDW were positively correlated. RDW value of 13.55 predicted EFT thickness >5 mm with a sensitivity of 61.7% and specificity of 58.8% (area under the curve [AUC]: 0.649 and P = 0.001). HgA1C value of >7 predicted EFT thickness ≥4.15 mm with a sensitivity of 60.7% and specificity of 60.4% (AUC: 0.651 and P

Serum uric acid could be served as an independent marker for increased risk and severity of ascending aortic dilatation in Behçet's disease patients.

This study aimed to investigate the correlation of serum uric acid (SUA) with risk and dilatation diameter of ascending aortic dilatation (AAD) in Behçet's disease (BD) patients. Seventeen BD patients complicated with AAD and 20 BD patients without AAD were consecutively enrolled and categorized into AAD group and control group, respectively. Ascending aortic dilatation was determined by two-dimensional doppler echocardiographic examination, and AAD was defined as a diameter of ascending aorta ≥3.8 and <4.4cm. SUA was detected by quantitative immunoassay method. Ascending aortic dilatation patients presented with higher proportion of male patients (P=0.003), hypertension occurrence (P=0.036) and increased diameter of ascending aorta (P<0.001) compared to controls. SUA was elevated in AAD patients compared to controls (P=0.002), and receiver operating characteristic curve displayed that SUA presented with great predictive value for AAD risk in BD patients with area under curve (AUC) 0.821 (95% CI 0.675-0.966). Pearson's analysis also disclosed that SUA was positively correlated with ascending aortic diameter in total BD patients. However, no difference of CRP (P=0.219) or ESR (P=0.320) between AAD patients and controls was observed, and no correlation of CRP (R=-0.150, P=0.377) or ESR (R=0.067, P=0.692) with ascending aortic diameter in total BD patients was discovered either. Further multivariate logistic regression illuminated that SUA was an independent factor predicting AAD risk in BD patients (P=0.031). Serum uric acid could be served as an independent marker for increased risk and severity of AAD in BD patients.

THE INFLUENCE OF GENDER ON LEFT VENTRICULAR MECHANICS IN HYPERTENSIVE PATIENTS

Objective: The aim of this study was to evaluate the influence of gender on left ventricular (LV) mechanics in hypertensive individuals. Design and method: This cross-sectional study included 198 untreated hypertensive subjects and 107 normotensive controls who underwent 24-hour ambulatory blood pressure monitoring and comprehensive two-dimensional echocardiographic examination including strain assessment. Results: There was no difference in 24-h blood pressure between hypertensive men and women. LV mass index was significantly higher men than in women in hypertensive and normotensive group. Hypertensive men and women had significantly lower 2D LV global longitudinal, circumferential and radial strains than their normotensive counterparts. LV global longitudinal strain was lower in hypertensive men than in women (−20.2 ± 2.3 vs. −18.8 ± 2.0, p < 0.01). LV global circumferential strain was also worse in hypertensive men than in men (−21.4 ± 2.9 vs. −19.5 ± 2.5, p < 0.01). The difference in LV radial strain was not discovered between hypertensive women and men. Assessment of layer-specific LV strain showed that endocardial and mid-myocardial longitudinal and circumferential strains were significantly lower in hypertensive population and especially in hypertensive men comparing with hypertensive women. Furthermore, LV twist was significantly higher in hypertensive women than in hypertensive men (20.6 ± 6.8 degree vs. 21.6 ± 7.3 degree, p = 0.02). Female gender and arterial hypertension, as well as their interaction, were associated with LV hypertrophy, reduced LV global longitudinal strain and increased LV twist. Conclusions: LV longitudinal and circumferential strains were significantly reduced in hypertensive patients. Endo- and mid-myocardial LV layers were particularly influenced by arterial hypertension. However, hypertensive women suffered more significant changes in LV longitudinal strain and LV twist than hypertensive men.

Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction.

Sensitive cardiac troponin I (cTnI) predicts all-cause and cardiovascular mortality in various clinical settings. However, its clinical significance in hemodialysis (HD) patients with preserved left ventricular ejection fraction (LVEF) has not been fully elucidated. This study investigated the association of cTnI with LV morphology and function, and its long-term outcome in HD patients with preserved LVEF. This prospective study consists of 96 HD patients with preserved LVEF (69 ± 8years and 63% male) who underwent two-dimensional echocardiographic examination and biomarker tests including cTnI, brain natriuretic peptide, and high-sensitive C-reactive protein. The primary endpoint was all-cause death and secondary endpoint was cardiovascular death. Factors independently associated with cTnI were systolic blood pressure (β = - 0.239, p = 0.011), heart rate (β = 0.216, p = 0.021), LV mass index (β = 0.231, p = 0.020), and E to e' ratio (β = 0.237, p = 0.016). During a mean follow-up of 3.6years, primary and secondary endpoints were observed in 23 (24%) and 18 (19%) patients, respectively. In the multivariate Cox proportional hazard analysis, the upper cTnI tertile has significantly increased risk of all-cause mortality [hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.139-6.386; p = 0.024] and that of cardiovascular death (HR, 4.56; 95% CI 2.021-16.968; p = 0.006) independent of echocardiographic measures and other serum biomarkers. In HD patients with preserved LVEF, serum cTnI levels were significantly associated with diastolic function and risk of mortality independent of echocardiographic variables and other biomarkers.

Normal Reference Ranges for Transthoracic Echocardiography Following Heart Transplantation

Heart function following heart transplantation (HTx) is influenced by numerous factors. It is typically evaluated using transthoracic echocardiography, but reference values are currently unavailable for this context. The primary aim of the present study was to derive echocardiographic reference values for chamber size and function, including cardiac mechanics, in clinically stable HTx patients. The study enrolled 124 healthy HTx patients examined prospectively. Patients underwent comprehensive two-dimensional echocardiographic examinations according to contemporary guidelines. Results were compared with recognized reference values for healthy subjects. Compared with guidelines, larger atrial dimensions were seen in HTx patients. Left ventricular (LV) diastolic volume was smaller, and LV wall thickness was increased. With respect to LV function, both ejection fraction (62±7%, P<.01) and global longitudinal strain (-16.5±3.3%, P<.0001) were lower. All measures of right ventricular (RV) size were greater than reference values (P<.0001), and all measures of RV function were reduced (tricuspid annular plane systolic excursion 15±4mm [P<.0001], RV systolic tissue Doppler velocity 10±6cm/sec [P<.0001], fractional area change 40±8% [P<.0001], and RV free wall strain -16.9±4.2% [P<.0001]). Ejection fraction and LV global longitudinal strain were significantly lower in patients with previous rejection. The findings of this study indicate that the distribution of routinely used echocardiographic measures differs between stable HTx patients and healthy subjects. In particular, markedly larger RV and atrial volumes and mild reductions in both LV and RV longitudinal strain were evident. The observed differences could be clinically relevant in the assessment of HTx patients, and specific reference values should be applied in this context.

BP.05.06] DOES NIGHTTIME HYPERTENSION IMPACT LEFT VENTRICULAR MECHANICS?

Objective: The aim of this study was to evaluate left ventricular (LV) mechanics in individuals with daytime, nighttime and day-nighttime hypertension (HT). Design and method: This cross-sectional study included 236 untreated subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and complete two-dimensional echocardiographic examination (2DE) including strain analysis. According to current guidelines, night-time hypertension was defined as nocturnal systolic BP > = 120 mm Hg or diastolic BP > = 70 mm Hg and day-time hypertension as systolic BP > 135 mm Hg and diastolic BP >85 mm Hg. Results: Using aforementioned criteria, the study sample included 68 normotensive subjects (29%), 51 isolated daytime HT (22%), 45 isolated nighttime HT (19%) and 72 day-nighttime HT (30%). 2DE LV longitudinal strain gradually and significantly decreased from normotensive subjects across daytime and nighttime HT patients to day-nighttime HT individuals (−21.8 ± 2.6 vs. −19.4 ± 2.3 vs. −18.8 ± 2.4 vs. −17.8 ± 2.1%, p < 0.001, respectively). The same direction of changes was also obtained for 2DE LV circumferential strain (−22.6 ± 3.1 vs. −20.9 ± 2.7 vs. −19.7 ± 2.6 vs. −18.2 ± 2.7%, p < 0.001, respectively). 2DE radial strain was significantly lower in nighttime HT and day-nighttime HT patients than in controls (39.4 ± 8.8 vs. 37.7 ± 9.1 vs. 35.1 ± 7.8 vs. 34.0 ± 8.0, p = 0.001, respectively). LV twist increased from normotensive subjects across daytime and nighttime HT patients to day-nighttime HT individuals (18.0 ± 6.3 vs. 19.7 ± 6.6 vs. 21.4 ± 7.1 vs. 22.2 ± 7.5 < degree>, p = 0.005, respectively). 24 h systolic BP fall was associated with peak LV longitudinal (β=−0.477, p < 0.001), LV circumferential strain (β=−0.405, p < 0.001), and LV twist (β=0.389, p < 0.001) in the whole study population independent of LV mass index and E/e’ ratio. Conclusions: Nighttime HT significantly impacts LV mechanics, which gradually deteriorated from normotensive controls, across isolated day- and nighttime HT, to day-nighttime HT. 24-hour systolic BP is associated with LV longitudinal and circumferential strains, as well as LV twist, independently of LV structure and diastolic function.

The relationship between nighttime hypertension and left atrial function.

The authors sought to investigate the association between different hypertensive phenotypes and left atrial (LA) function assessed by the volumetric method and the strain method in patients with untreated hypertension. This cross-sectional study involved 236 untreated patients who underwent 24-hour ambulatory blood pressure monitoring and two-dimensional echocardiographic examination. Our findings showed that LA function gradually deteriorated from patients with normotension, across patients with daytime hypertension, to patients with night- and day-nighttime hypertension. LA reservoir and conduit functions were particularly deteriorated in patients with nighttime and day-nighttime hypertension compared with patients with normotension and patients with daytime hypertension, whereas LA pump function was compensatorily increased only in the participants with day-nighttime hypertension. Only nighttime hypertension and day-nighttime hypertension were independently associated with the reduced reservoir and conduit LA function. The difference between patients with daytime and nighttime hypertension was found in reservoir and conduit LA but not LA pump function.

The influence of night-time hypertension on left ventricular mechanics

ObjectiveThe aim of this study was to evaluate left ventricular (LV) mechanics in individuals with daytime, night-time and day-nighttime hypertension. MethodsThis cross-sectional study included 272 untreated subjects who underwent 24-hour ambulatory blood pressure monitoring and complete two-dimensional echocardiographic examination including strain analysis. According to current guidelines, night-time hypertension was defined as nocturnal systolic blood pressure≥120mmHg and/or diastolic blood pressure≥70mmHg and day-time hypertension as systolic blood pressure≥135mmHg and/or diastolic blood pressure≥85mmHg. ResultsThe study sample included 61 normotensive subjects (22%), 77 isolated daytime hypertension (28%), 40 isolated night-time hypertension (15%) and 94day-nighttime hypertension (35%). LV longitudinal and circumferential strain gradually and significantly decreased from normotensive subjects across patients with isolated daytime and night-time hypertension to hypertensive individuals with persistent hypertension. Radial strain was similar between the observed groups. LV twist increased from normotensive subjects across isolated daytime and night-time hypertensive patients to day-nighttime hypertensive individuals. Hypertensive patients with day-nighttime and night-time hypertension are significantly more associated with decreased longitudinal and circumferential strain than hypertensive patients with isolated day-time hypertension and normotension. ConclusionLV mechanics gradually deteriorated from normotensive controls, across isolated day- and night-time hypertension, to day-nighttime hypertension. Patients with night-time and day-nighttime hypertension are associated with higher risk of LV mechanical dysfunction than normotensives and day-time hypertensives.

Echocardiographic findings in infants with presumed congenital Zika syndrome: Retrospective case series study.

ObjectiveTo report the echocardiographic evaluation of 103 infants with presumed congenital Zika syndrome.MethodsAn observational retrospective study was performed at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil. 103 infants with presumed congenital Zika syndrome. All infants had microcephaly and head computed tomography findings compatible with congenital Zika syndrome. Zika IgM antibody was detected in cerebrospinal fluid samples of 23 infants. In 80 infants, the test was not performed because it was not available at that time. All infants had negative serology for HIV, syphilis, rubella, cytomegalovirus and toxoplasmosis. A complete transthoracic two-dimensional, M-mode, continuous wave and pulsed wave Doppler and color Doppler echocardiographic (PHILIPS HD11XE or HD15) examination was performed on all infants.Results14/103 (13.5%) echocardiograms were compatible with congenital heart disease: 5 with an ostium secundum atrial septal defect, 8 had a hemodynamically insignificant small apical muscular ventricular septal defect and one infant with dyspnea had a large membranous ventricular septal defect. The echocardiograms considered normal included 45 infants with a persistent foramen ovale and 16 with a minimum patent ductus arteriosus.ConclusionsPreliminarily this study suggests that congenital Zika syndrome may be associated with an increase prevalence of congenital heart disease. However the types of defects noted were septal defects, a proportion of which would not be hemodynamically significant.

The relationship between right ventricular deformation and heart rate variability in asymptomatic diabetic patients

ObjectiveTo investigate heart rate variability (HRV) and right ventricular (RV) remodeling in asymptomatic diabetic patients, as well as the relationship between HRV indices and RV structure, function and deformation. MethodThis cross-sectional study included 59 asymptomatic patients with type 2 diabetes and 45 healthy controls without cardiovascular risk factors. All study subjects underwent 24-h Holter monitoring, laboratory analyses and complete two-dimensional echocardiography examination (2DE). ResultsRV diastolic function and longitudinal deformation were significantly impaired in diabetic individuals comparing with controls. RV global longitudinal strain and layer-specific longitudinal strains were significantly decreased in diabetic group. The same trend of changes in RV deformation was observed for global RV and lateral wall. All parameters of time and frequency domain of HRV were reduced in diabetic subjects. RV endocardial longitudinal strain together with LV mass index, mitral E/e’ ratio and HbA1c correlated with HRV parameters. However, multivariate linear regression analysis showed that only RV endocardial longitudinal strain and LV mass index are associated with HRV parameters independently of age, BMI, HbA1c, RV free wall thickness and pulmonary artery pressure. ConclusionsRV subendocardial strain is independently associated with HRV parameters in the whole study population. This reveals potentially important role of determination of layer-specific RV longitudinal function as important marker of preclinical cardiac damage, but also indirectly show the impairment of cardiac autonomic function in diabetic patients.

Expression of Fc < gamma > Rs on monocytes among Kawasaki disease patients with coronary artery lesions

ObjectiveTo study expression of Fc gamma receptors (Fc<gamma>Rs) on monocytes in Kawasaki disease (KD) patients with coronary artery lesions (CAL). Methods160 newly diagnosed KD patients and 80 health children were enrolled in this study. All patients were scheduled to receive both aspirin and intravenous immunoglobulin (IVIG). Serial blood samples were obtained before and 3days after completing IVIG therapy. The first two-dimensional echocardiographic examination was performed for all KD patients within 10days, and was repeated at 3weeks. CAL was defined by coronary artery Z-scores≥2.5 by echocardiography. Expression of inhibitory and activating Fc<gamma>Rs on CD14+ monocytes (MCs) was assessed by flow cytometry. Cytokine expression in MC was evaluated by PCR. ResultsOf the 160KD patients enrolled in this study, 36 had coronary artery lesions (KD-CAL+ group), while 124 did not (KD-CAL− group). There was no significant difference in Fc<gamma>RI expression on MCs from KD patients and that of Ctrls. Although Fc<gamma>RIII and Fc<gamma>RIIa levels were significantly higher in KD patients compared with those in Ctrls, there were no significant differences between the KD-CAL+ and KD-CAL− groups. Fc<gamma>RIIb expression in the KD patients was lower than that of Ctrls, meanwhile expression in the KD-CAL+ group was lower than that in the KD-CAL− group. After IVIG therapy, Fc<gamma>RIIb expression increased in KD-CAL+, but did not reach the normal range. A negative correlation was observed between the levels of IL-6, TNF-α and Fc<gamma>RIIb expression. ConclusionDecreased Fc<gamma>RIIb expression on MCs may contribute to the development of coronary artery lesions in patients with KD.

The Role of Transesophageal Echocardiography in Adolescents and Adults with Congenital Heart Disease

There is frequent dropout of atrial septal echoesin the region of the fossa ovalis in the standard precordial echocardiographic imaging planes, that can be minimized by use of the subcostal imaging approach. The diagnostic sensitivity of this approach was reviewed in 154 patients (mean age 31 years, range 18years to 45 yrs) with documented atrial septal defect in whom a satisfactory image of the atrial septum could be obtained.Subcostal two-dimensional and color Doppler echocardiography successfully visualized 93 (89%) of the 105 ostium secundum atrial septal defects, all 32 (100%) ostium Primum defects and 7 (44%) of the 16 sinus vinosus defects. A defect was not visualized (false negative response) in 12 patients (11 %) with an ostium secundum defect and in 9 patients (56%) with a sinus venosus defect. In three of the former and five of the latter, a two-dimensional echocardiographic contrast examination and transesophageal echocardiography established the presence of the inter-atrial shunt. Forty eight patients (32 %) with clinical findings of uncomplicated atrial septal defect confirmed by two-dimensional,color Doppler and Transesophageal echocardiography underwent surgical repair of the defect without preoperative cardiac catheterization. There were no perioperative complications.University Heart Journal Vol. 11, No. 2, July 2015; 63-67

Left atrial phasic function and heart rate variability in asymptomatic diabetic patients.

We evaluated left atrial (LA) phasic function and heart rate variability (HRV) in asymptomatic diabetic patients, and the relationship between HRV indices and LA phasic function assessed by volumes and speckle tracking imaging. This cross-sectional study included 55 asymptomatic patients with type 2 diabetes and 50 healthy controls without cardiovascular risk factors. All study subjects underwent laboratory analyses, complete two-dimensional echocardiography examination (2DE) and 24-h Holter monitoring. Maximum, minimum LA and pre-A LA volumes and volume indexes are significantly higher in diabetic patients. Total and passive LA emptying fractions (EF), representing the LA reservoir and conduit function, are significantly lower in diabetic subjects. Active LA EF, the parameter of the LA booster pump function, is compensatory increased in diabetic patients. Similar results were obtained by 2DE strain analysis. Cardiac autonomic function, assessed by HRV, is significantly deteriorated in diabetic patients. Time and frequency-domain HRV measures are significantly lower in diabetic subjects than in controls. HbA1c, LV mass index and HRV are associated with total LA EF and longitudinal LA strain independently of age, body mass index and LV diastolic function in the whole study population. LA phasic function and cardiac autonomic nervous system assessed by HRV are impacted by diabetes. HbA1c and HRV are independently associated with LA reservoir function evaluated by volumetric and strain methods in the whole study population. This study emphasizes the importance of determination of LA function and HRV as important markers of preclinical cardiac damage and autonomic function impairment in diabetic patients.

Diagnostic accuracy of electrocardiographic P wave related parameters in the assessment of left atrial size in dogs with degenerative mitral valve disease.

The purpose of this research was to compare the accuracy of newly described P wave-related parameters (P wave area, Macruz index and mean electrical axis) with classical P wave-related parameters (voltage and duration of P wave) for the assessment of left atrial (LA) size in dogs with degenerative mitral valve disease. One hundred forty-six dogs (37 healthy control dogs and 109 dogs with degenerative mitral valve disease) were prospectively studied. Two-dimensional echocardiography examinations and a 6-lead ECG were performed prospectively in all dogs. Echocardiography parameters, including determination of the ratios LA diameter/aortic root diameter and LA area/aortic root area, were compared to P wave-related parameters: P wave area, Macruz index, mean electrical axis voltage and duration of P wave. The results showed that P wave-related parameters (classical and newly described) had low sensitivity (range=52.3 to 77%; median=60%) and low to moderate specificity (range=47.2 to 82.5%; median 56.3%) for the prediction of left atrial enlargement. The areas under the curve of P wave-related parameters were moderate to low due to poor sensitivity. In conclusion, newly P wave-related parameters do not increase the diagnostic capacity of ECG as a predictor of left atrial enlargement in dogs with degenerative mitral valve disease.

The relationship between heart rate variability and left ventricular layer-specific deformation in uncomplicated diabetic patients.

The aim of this study was to investigate heart rate variability (HRV) and left ventricular (LV) remodeling in uncomplicated diabetic patients. Furthermore, we sought to investigate the association between HRV indices and LV structural, functional and mechanical parameters. This cross-sectional study included 50 uncomplicated patients with type 2 diabetes and 40 healthy controls without cardiovascular risk factors. All study subjects underwent 24-h Holter monitoring, laboratory analyses and complete two-dimensional echocardiography examination (2DE). LV structure and diastolic function were significantly deteriorated in the diabetic patients comparing with the controls. LV global longitudinal, circumferential and radial strains were significantly reduced in the diabetic group. LV endocardial, mid-miocardial and epicardial longitudinal and circumferential strains were significantly decreased, whereas LV twist was significantly increased, in the diabetic patients; 24-h, daytime and nighttime heart rates were higher in the diabetic patients. All parameters of time and frequency domain of HRV were reduced in the diabetic subjects. LV mass index, mitral E/e' ratio and 2DE LV endocardial and mid-miocardial longitudinal and circumferential strains correlated with HRV parameters. A multivariate regression analysis showed that E/e' ratio and 2DE LV layer-specific strains were associated with HRV parameters independently of age, BMI, systolic blood pressure and LV mass index. HRV and LV mechanics are significantly deteriorated in uncomplicated diabetic individuals. Parameters of LV remodeling are independently associated with HRV indices, which could indicate the importance of HRV determination in diabetics.

OP.4B.01] LEFT VENTRICULAR MECHANICS IN PATIENTS WITH MASKED HYPERTENSION

Objective: We sought to investigate left ventricular (LV) mechanics in subjects with masked hypertension (MH), normotensive and sustained hypertensive patients. Design and method: This cross-sectional study included 209 untreated subjects who underwent 24-hour ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE) including multilayer strain analysis. MH was diagnosed if clinic blood pressure (BP) was normal (<140/90 mmHg) and 24-hour BP was increased (> = 130/80 mmHg). Results: According to criteria provided in the Methods, the study sample included 62 normotensive subjects (30%), 64 MH (30%) and 83 sustained hypertensives (40%). 2DE LV longitudinal strain gradually and significantly decreased from normotensive controls across MH individuals to sustained hypertensive patients (−21.3 ± 2.1 vs. −19.1 ± 2 vs. −17.4 ± 1.8 %, p < 0.001). The same is valid for 2DE LV circumferential strain (−21.9 ± 2.9 vs. −20 ± 2.5 vs. −18.4 ± 2.2 %, p < 0.001). 2DE radial strain was not different between groups. 2DE LV longitudinal endocardial and mid-myocardial layer strains progressively decreased from normotensive control to sustained hypertensive individuals (−26.4 ± 4.6 vs. −23.8 ± 3.8 vs. −21 ± 3.6 %, p < 0.001 for endocardial strain; and −21 ± 3.2 vs. −18.8 ± 2.8 vs. −16.8 ± 2.5 %, p < 0.001 for mid-myocardial strain). Similar results were obtained for 2DE LV circumferential endocardial and mid-myocardial layer strains (−28.6 ± 5 vs. −25.4 ± 4.4 vs. −23.2 ± 4 %, p < 0.001 for endocardial strain; and −21.5 ± 2.8 vs. −19.4 ± 2.4 vs. −18.2 ± 2.2 %, p < 0.001 for mid-myocardial strain). Longitudinal and circumferential epicardial layer strains were decreased in sustained hypertensive patients than in normotensive controls. 24-hour systolic BP was associated with peak 2DE LV longitudinal (β = −0.442, p < 0.001), endocardial strain (β = −0.394, p < 0.001), mid-myocardial strain (β = −0.426, p < 0.001) and 2DE circumferential endocardial strain (β = −0.364, p < 0.001) in the whole study population independent of LV mass index and E/e’ ratio. Conclusions: MH significantly influences LV deformation assessed by 2DE traditional strain and 2DE multilayer strain. 24-hour systolic BP is associated with LV deformation evaluated with comprehensive 2DE strain analysis independent of LV structure and diastolic function.

The influence of white-coat hypertension on left atrial phasic function

We aimed to investigate the association between white-coat hypertension (WCH) and left atrial (LA) phasic function assessed by the volumetric and speckle tracking method. This cross-sectional study included 52 normotensive individuals, 49 subjects with WCH and 56 untreated hypertensive patients who underwent a 24-h ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE). WCH was diagnosed if clinic blood pressure (BP) was elevated and 24-h BP was normal. We obtained that maximum, minimum LA and pre-A LAV volumes and volume indexes gradually and significantly increased from the normotensive subjects, throughout the white-coat hypertensive individuals to the hypertensive patients. Passive LA emptying fraction (EF), representing the LA conduit function, gradually reduced from normotensive to hypertensive subjects. Active LA EF and the parameter of the LA booster pump function increased in the same direction. Similar results were obtained by 2DE strain analysis. The LA stiffness index gradually increased from normotensive controls, throughout white-coat hypertensive subjects to hypertensive patients. Clinic systolic BP was associated with LA passive EF (β= −0.283, p = 0.001), LA active EF (β = 0.342, p < 0.001), LA total longitudinal strain (β= −0.356, p < 0.001), LA positive longitudinal strain (β= −0.264, p = 0.009) and LA stiffness index (β = 0.398, p < 0.001) without regard to age, BMI, left ventricular structure and diastolic function in the whole study population. In the conclusion, WCH significantly impacts LA phasic function and stiffness. Clinic systolic BP was associated with functional and mechanical LA remodeling in the whole study population.

Does masked hypertension impact left ventricular deformation?

Our aim was to compare left ventricular (LV) deformation in subjects with masked hypertension (MH) to normotensive and sustained hypertensive patients. This cross-sectional study included 185 untreated subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and complete two-dimensional echocardiographic (2DE) examination including multilayer strain analysis. MH was diagnosed if clinic BP was normal (<140/90 mm Hg), and 24-hour BP was increased (≥130/80 mm Hg). 2DE LV longitudinal and circumferential strains gradually and significantly decreased from normotensive controls across MH individuals to sustained hypertensive patients. 2DE radial strain was not different between groups. 2DE longitudinal and circumferential endocardial and midmyocardial layer strains progressively decreased from normotensive control to sustained hypertensive individuals. Longitudinal and circumferential epicardial layer strains were lower in sustained hypertensive patients than in normotensive controls. Clinic and 24-hour systolic BP were associated with 2DE LV longitudinal endocardial strain, midmyocardial strain, and 2DE circumferential endocardial strain in the whole-study population independent of LV structure and diastolic function. MH significantly affect LV deformation assessed by 2DE traditional strain and 2DE multilayer strain. Clinic and 24-hour systolic BP were associated with LV mechanics evaluated with comprehensive 2DE strain analysis independent of LV structure and diastolic function.

The influence of type 2 diabetes and arterial hypertension on right ventricular layer-specific mechanics

The aim of the investigation was to evaluate layer-specific right ventricular (RV) deformation in normotensive and hypertensive subjects with type 2 diabetes mellitus (DM). This cross-sectional study included 129 subjects (40 controls, 42 normotensive DM and 47 hypertensive DM patients) who underwent complete two-dimensional echocardiographic examination (2DE) including multilayer strain analysis. 2DE RV global and free wall longitudinal strains were reduced in normotensive and hypertensive DM subjects than in controls. RV global longitudinal layer-specific strains (endo-, mid- and epicardial) were lower in normotensive and hypertensive DM patients than in controls. On the other side, layer-specific strains of RV free wall were lower in hypertensive DM patients than in controls, without significant difference between controls and normotensive DM subjects. Parameters of DM control (fasting glucose and glycosylated hemoglobin) were associated with 2DE RV global longitudinal endo- and mid-myocardial layer strain. Diabetes and hypertension significantly influence RV mechanics assessed by 2DE conventional and 2DE multilayer strain. Hypertension has an additive unfavorable influence on RV deformation in diabetic patients. Laboratory parameters of diabetic control were associated with RV structure, diastolic function and mechanics assessed with complex 2DE strain analysis.