"Dipper" ve "Non-dipper" hipertansiyon olgularında sol ventrikülün sistolik fonksiyonunun iki boyutlu longitudinal strain görüntüleme ile değerlendirilmesi
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Date
2014
Authors
Habibova, Ulvin
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Publisher
Tıp Fakültesi
Abstract
The blood pressure (BP) has circadian rhythm and fluctuates in 24 hours. The studies done by Ambulatory Blood Pressure Monitoring (ABPM), which is capable for 24–hours tracking of BP, has been classified hypertension (HT) patients as "dipper" if nighttime BP levels decreased 10% or more compared to daytime values and "non-dipper" if the reduction is less than 10%. "Non-dipper" HT cases has higher rates of target organ damage that increases the cardiovascular morbidity and mortality. It is known that an abnormal circadian BP pattern can affect left ventricular (LV) systolic function. Two-dimensional (2D) deformation analysis, that have been developed recently, can detect subclinical LV systolic dysfunction at an early stage which can not be determined by conventional echocardiography (ECHO). The aim of the study was to assess the role of 2D speckle tracking strain imaging on detecting subclinical LV systolic dysfunction in recently diagnosed "non-dipper" and "dipper" hypertensive patients whose LV systolic functions were normal by conventional ECHO. Material and Methods: Patients admitted to the Cardiology Department of Ankara University Faculty of Medicine and diagnosed newly with essential hypertension were enrolled in the study. According to the ABPM results hypertensive patients were divided into two groups as "dippers" and "non-dippers". If left ventricular systolic functions and regional wall motions were determined as normal by conventional ECHO, then apical four, three and two chamber views were recorded in gray scale. 2D global and segmental longitudinal strain analysis was conducted by speckle tracking method. Global and segmental systolic strain and strain rates were measured. Global longitudinal strain (GLS) and global longitudinal strain rates (GLSR) were calculated as arithmetic average of all segmental longitudinal strain and strain rates. The study included 40 recently diagnosed hypertensive patients. Results: According to the ABPM, 32 patients were classified as "non-dippers" whereas 8 were "dippers". The average age of the patients in both of the groups was similar (49.5 ± 12.4 years vs. 52.0 ± 13.5 years, p=0.85). 70% of the cases were men. No meaningful statistical difference was determined between the groups' demographical features and laboratory data. The patients were on similar cardiovascular drugs. There was no statistically difference between the "non-dippers" and "dippers" in the left ventricular diameters, mass, mass index, and EF. 2D speckle tracking analysis showed that mean GLS and GLSR were similar between the groups. LV segmental analyses, also, showed that regional strain and strain rates were not different between the observed groups. Conclusion: In our study, 2D speckle tracking examination demonstrated that LV global and segmental strain and strain rates were not different between the "non-dipper" and "dipper" hypertensive patients. But, further larger and prospective studies are needed to evaluate the value of that newer technique.
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Keywords
Hipertansiyon,, "non-dipper"