[PP.24.25] LEFT VENTRICULAR MASS: HOW CAN IT INTERFERE WITH THE SPECKLE TRACKING TECHNIQUE ACCURACY IN DETECTION OF CORONARY LESIONS. (September 2017)

• Record Type: Journal Article
• Authors: Stefan, C.; Onut, R.; Roatesi, L.; Zamfir, D.; Stoian, M.; Onciul, S.; Dorobantu, M.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523857.39699.4a
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Hypertensive patients develops left ventricular hypertrophy over time, through various mechanisms. The increase in left ventricular mass alters relaxation but also contractility. The objective of our study was to highlight the longitudinal strain alteration in patients with increased ventricular mass. Design and method: We performed transthoracic echocardiography in a cohort of patients presented with acute chest pain without criteria for cardiac emergencies and without an obvious cause of non-cardiac pain. We studied left ventricular mass by area-length method from short axis view and myocardial deformation using two-dimensional speckle tracking technique expressed by global longitudinal strain on 18 (SLG18), 12 (SLG12) and 6 (SLG6) segments. To detect significant epicardial coronary stenosis (> 70%), all patients underwent elective coronary angiography. Results: We studied a cohort of 64 patients with a mean age of 56.4 ± 10 years; 50% were women and 50% men. The average left ventricular mass in hypertensive patients was 153.7 g ± 29.5 compared with 149 g ± 34.5 in normotensive patients, but the difference was not statistically significant (t (39)= −0.429, p = 0.67), probably due to the small number of patients. Left ventricular mass inversely correlated, statistically significant, with myocardial deformation measured on SLG18 (r = 0.473, p < 0.001), SLG12 (r = 0.523, p < 0.001) and SLG6 (r = 0.495, p < 0.001). After performing coronary angiography, 41 patients (64%) had no significant coronary lesions and 23 patients (36%) had coronary stenosis > 70%. After exclusion of patients with significant coronary lesions, the correlation between left ventricular mass and alteration of deformation remains statistically significant for GLS18 (r = 0.483, p = 0.001), GLS12 (r = 0.552, p < 0.001) and GLS6 (r = 0.564, p < 0.001). Conclusions: Increased left ventricular mass alters myocardial deformation, correlation that remains significant regardless of the presence of coronary lesions. In patients with significant ventricular hypertrophy, myocardial deformation analysis using speckle tracking techniques have lower specificity in detecting coronary lesions. Ventricular hypertrophy alters not only the diastolic function but also the longitudinal contractility. LV mass and geometry assessed by 2D echocardiography stratify the risk in patients with essential hypertension independently of other risk factors.