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Impaired left ventricular torsion and delayed untwisting in hypertension without left ventricular hypertrophy
  1. ESP Lee1,
  2. YT Tan2,
  3. FWG Wenzelburger2,
  4. G Heatlie1,
  5. MP Frenneaux2,
  6. JE Sanderson2
  1. 1University Hospital of North Staffordshire, Stoke on Trent, UK
  2. 2University of Birmingham, Birmingham, UK

Abstract

Background Hypertension associated with left ventricular hypertrophy (LVH) is known to be associated with myocardial dysfunction. However, early changes are not apparent on conventional echocardiography. Two-dimensional (2D) speckle tracking has been used to detect subtle changes in left ventricular regional function in patients with LVH but little is known of left ventricular rotation, torsion and untwist in hypertensive patients without LVH.

Methods We recruited 43 hypertensive patients without LVH on echocardiography (27 women, aged 70 ± 12 years, left ventricular mass index (LVMI) 77 ± 19, left atrial volume index (LAVI) 30 ± 12, ejection fraction (EF) 59 ± 8%) and 30 healthy controls (22 women, aged 69 ± 7 years, LVMI 78 ± 19, LAVI 23 ± 8, EF 63 ± 8%). All underwent full echocardiography and images were analysed offline. 2D speckle tracking was used to study apical rotation and basal rotation. Left ventricular torsion was calculated and corrected to left ventricular length. Left ventricular torsions  =  (apical rotation − basal rotation)/left ventricular length. The amount of left ventricular untwisting at 25%, 50% and 75% of untwisting time were calculated from the apical rotation curve.

Results Patients with hypertension had significantly lower apical rotation and left ventricular torsion compared with controls. Apical rotation was 9.62 ± 4.1 degrees and 12.84 ± 3.4 degrees, p = 0.002. Left ventricular torsion was 2.49 ± 0.9 and 3.14 ± 0.5, p = 0.012. Early, mid and late untwist were also more delayed in the patient group. During early left ventricular untwisting, 24 ± 11% untwist was completed in the patient group compared with 31 ± 11% in controls, p = 0.027. This pattern continued through to the mid and late stages of untwist: 50 ± 13% untwist and 59 ± 10% untwist, respectively, completed at 50% of total untwisting time, p = 0.008; 73 ± 9% untwist and 81 ± 8% untwist, respectively, at 75% of total untwisting time, p = 0.011 (see tables 1 and 2).

Abstract 115 Table 1.

Abstract 115 Table 2.

Conclusion Hypertension, before the onset of LVH, is associated with significant systolic and diastolic disturbances. 2D speckle tracking can detect signs of early disease progression.

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