الفهرس 
Chapter I: Basic Principles of Speckle Tracking EchocardiographyOnly 14 pages are availabe for public view
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Abstract
Hypertension is a major risk factor for a number of cardiovascular diseases including stroke, atherosclerosis and coronary heart disease.
Hypertensive patients show subtle changes of LV as well as aortic root mechanics which can be identified by tissue deformation imaging that enables objective assessment of regional and global myocardial deformation; strain and strain rate using myocardial and aortic root Doppler data.
It also permits detection of early changes in LV diastolic function in hypertensive patients free from clinical manifestations of HF as the earliest myocardial impairment involves the longitudinal fibers.
Objective:
The main aim of this study was to assess aortic root mechanics in relation to left ventricular mechanics in hypertensive patients by speckle tracking echocardiography.
Methodology:
This is a cross-sectional study that enrolled 50 patients, patients were categorized into 2 groups. The first group (group A) consisted of 20 patients who were normal control subjects, and the second group (group B) consisted of 30 patients who were hypertensive.
The study was performed on patients presented to Cardiology outpatient clinic, Menoufia University Hospitals, the mean age and SD for group A was 45.85 ± 12.31 years including 9 female subjects and 11 male subjects while the mean age and SD for group B was 51.57 ± 10.93 years including 13 female subjects and another 17 male subjects. So, there were insignificant difference between both group as regard age and gender distribution.
Results:
Regarding Conventional 2D Echocardiography:
IVSd, LVPWd, LA diameter, and aortic root diameter, SBP, DBP, PP, and aortic systolic and diastolic diameters wave velocity were significantly higher in group B. While E wave velocity, E/A ratio, pulsatile aortic change in diameter and AOD were significantly higher in group A. The remaining parameters didn’t show differences at the level of statistical significance.
Regarding Mitral Annular TDI Echocardiography:
S and è wave velocities as well as è/à ratio were significantly higher in group A. While à wave velocity and E/è were significantly higher in group B. Whereas there were statistically insignificant differences between the studied groups regarding the remaining parameters.
Regarding LV Deformation Analysis:
There was a statistically insignificant difference between the studied groups regarding results of 2D-STE parameters of LV function except for peak untwist, global longitudinal peak systolic strain in all three views as well as averaged global longitudinal peak systolic strain.
Regarding Aortic Root Deformation Analysis:
As regard 2D-STE of aortic longitudinal strain of both anterior wall, posterior wall and averaged global aortic strains showed a statistically significant difference between the studied groups.
Correlation Analysis:
There was a significant correlation between global longitudinal strain of the ascending aorta and è wave velocity, E/è ratio, averaged GLPS and aortic distensibility. Other correlations than those previously mentioned didn’t show any statistical significance.
Hypertension is a major risk factor for several cardiovascular diseases, including stroke, atherosclerosis and coronary heart disease. Remodeling of the aortic root may be expected to occur in hypertensive subjects as a result of increased stress on the aortic wall due to the repeated hemodynamic overload. Two-dimensional speckle tracking echocardiography is a promising new imaging modality. The aim of this study is to assess aortic root mechanics in relation to left ventricular mechanics in hypertensive patients by speckle tracking echocardiography.
Methods:
The study included 50 individuals, 30 patients with hypertension compared with 20 age and sex matched healthy volunteers as control group. For both groups, conventional echo was done and speckle tracking echocardiography of the LV including longitudinal, circumferential, radial strain, LV rotation and the longitudinal strain of the ascending aorta and aortic distensibility were measured.
Results:
Aortic longitudinal strain of both anterior and posterior walls, and also LV longitudinal peak systolic strain were lower significantly in patient group, and also in the same group, the apical rotation was higher than control; aortic longitudinal strain was negatively correlated with E/E, and LV global longitudinal strain was correlated positively with septal annular E wave peak velocity and with aortic distensibility.
Conclusion:
Hypertension significantly lowers scending aortic longitudinal strain and the changes are correlated significantly with LV longitudinal systolic function and with echo parameters of elevated LV filling pressure.