.: ORİJİNAL ARAŞTIRMA
Evaluation of Global Left Ventricular Systolic Function in Newly Diagnosed Dipper and Non-dipper Hypertensive Patients by Strain Analysis Methods
Yeni Tanı Dipper ve Non-dipper Hipertansif Hastalarda Strain Analiz Metoduyla Sol Ventrikül Global Sistolik Fonksiyonlarının Değerlendirilmesi
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(2):71-7
doi: 10.5336/cardiosci.2021-81187
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Non-dipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional (2D) strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and Methods: We included 42 newly diagnosed hypertensive patients without a previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non-dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by 2D speckle tracking method. Results: The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of left ventricular (LV) systolic function by GLS showed decreased values in non-dippers compared with dippers (-18.13±2.07 vs. -13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), nighttime systolic and diastolic blood pressures, 24-hr systolic blood pressure, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with LV GLS. Conclusion: An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain.
Keywords: Hypertension; non-dipper; dipper; strain; mean arterial pressure
Objective: Non-dipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional (2D) strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and Methods: We included 42 newly diagnosed hypertensive patients without a previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non-dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by 2D speckle tracking method. Results: The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of left ventricular (LV) systolic function by GLS showed decreased values in non-dippers compared with dippers (-18.13±2.07 vs. -13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), nighttime systolic and diastolic blood pressures, 24-hr systolic blood pressure, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with LV GLS. Conclusion: An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain.
Keywords: Hypertension; non-dipper; dipper; strain; mean arterial pressure
ÖZET
Amaç: Non-dipper hipertansiyon, artmış hedef organ hasarı ve olumsuz kardiyovasküler olaylarla ilişkilidir. Dipper ve non-dipper hipertansif hastalarda 2 boyutlu strain ekokardiyografi ile kardiyak hasar değerlendirilmesi, daha önce kapsamlı bir şekilde araştırılmamıştır. Biz daha önceden tedavi almamış, yeni tanı hipertansif hastalarda dipper ve non-dipper paternin miyokardiyal deformasyon strain parametreleri üzerine olan etkisini araştırdık. Gereç ve Yöntemler: Çalışmamıza daha önceden kardiyovasküler veya kronik hastalığı olmayan 42 yeni tanı hipertansif hastayı dâhil ettik. Hastalar 23 dipper ve 19 non-dipper olarak 2 gruba ayrıldı. 'Global longitudinal strain (GLS)', radyal strain ve sirkümferansiyel strain analizleri 2 boyutlu 'speckle tracking' metodu ile yapıldı. Bulgular: Çalışmaya dâhil edilen 42 hastanın (15 erkek), ortalama yaşı 54,5±9 idi. Sol ventrikül sistolik fonksiyonlarının analizinde dipper grupta GLS, non-dipper gruba göre anlamlı olarak daha yüksek bulundu (-18,13±2,07 vs. -13,7±1,95; p=0,001). Fakat radyal veya sirkümferansiyel strainde 2 grup arasında anlamlı fark yoktu. Gece ortalama arter basıncı, gece ve gündüz sistolik kan basıncı, 24 saat sistolik kan basıncı, dipping oranı, gece ortalama arter basınç düşme oranı, GLS ile korele bulundu. Fakat bu parametrelerden sadece dipping oranı, GLS ile bağımsız olarak ilişkili bulundu. Sonuç: İzole non-dipper kan basıncı paterni, miyokardiyal strain ile saptanan sol ventrikül fonksiyonlarında bozulmayla ilişkilidir.
Anahtar Kelimeler: Hipertansiyon; non-dipper; dipper; strain; ortalama arter basıncı
Amaç: Non-dipper hipertansiyon, artmış hedef organ hasarı ve olumsuz kardiyovasküler olaylarla ilişkilidir. Dipper ve non-dipper hipertansif hastalarda 2 boyutlu strain ekokardiyografi ile kardiyak hasar değerlendirilmesi, daha önce kapsamlı bir şekilde araştırılmamıştır. Biz daha önceden tedavi almamış, yeni tanı hipertansif hastalarda dipper ve non-dipper paternin miyokardiyal deformasyon strain parametreleri üzerine olan etkisini araştırdık. Gereç ve Yöntemler: Çalışmamıza daha önceden kardiyovasküler veya kronik hastalığı olmayan 42 yeni tanı hipertansif hastayı dâhil ettik. Hastalar 23 dipper ve 19 non-dipper olarak 2 gruba ayrıldı. 'Global longitudinal strain (GLS)', radyal strain ve sirkümferansiyel strain analizleri 2 boyutlu 'speckle tracking' metodu ile yapıldı. Bulgular: Çalışmaya dâhil edilen 42 hastanın (15 erkek), ortalama yaşı 54,5±9 idi. Sol ventrikül sistolik fonksiyonlarının analizinde dipper grupta GLS, non-dipper gruba göre anlamlı olarak daha yüksek bulundu (-18,13±2,07 vs. -13,7±1,95; p=0,001). Fakat radyal veya sirkümferansiyel strainde 2 grup arasında anlamlı fark yoktu. Gece ortalama arter basıncı, gece ve gündüz sistolik kan basıncı, 24 saat sistolik kan basıncı, dipping oranı, gece ortalama arter basınç düşme oranı, GLS ile korele bulundu. Fakat bu parametrelerden sadece dipping oranı, GLS ile bağımsız olarak ilişkili bulundu. Sonuç: İzole non-dipper kan basıncı paterni, miyokardiyal strain ile saptanan sol ventrikül fonksiyonlarında bozulmayla ilişkilidir.
Anahtar Kelimeler: Hipertansiyon; non-dipper; dipper; strain; ortalama arter basıncı
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