Poremećaj deformacije miokarda procijenjen dvodimenzijskom studijom deformacije u hipertoničara s hipertrofijom interventrikulskoga septuma u izgonskom traktu lijeve klijetke [Myocardial deformation abnormalities assessed by two-dimensional deformation study in hypertensive patients with basal interventricular septal hypertrophy]

Rešković Lukšić, Vlatka (2018) Poremećaj deformacije miokarda procijenjen dvodimenzijskom studijom deformacije u hipertoničara s hipertrofijom interventrikulskoga septuma u izgonskom traktu lijeve klijetke [Myocardial deformation abnormalities assessed by two-dimensional deformation study in hypertensive patients with basal interventricular septal hypertrophy]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Background. A wide range of subclinical changes in left ventricular (LV) geometry and function may be observed, even in the early course of arterial hypertension (AH). Aims. To investigate if the appearance of isolated basal septal hypertrophy (BSH) could be a marker of incipient intrinsc LV dysfunction. Methods. A total of 138 patients with primary arterial hypertension, aged less than 65 years, with no comorbidities and with perserved LV ejection fraction (EF) were included. Complete transthoracic echocardiography study was preformed according to standardized protocol, as well as deformation study using speckle tracking echocardiography. Global and regional longitudinal strain was measured in apical 4-,2- and 3-chamber views according to 18-segments model. Global and regional circumferential and radial strains were measured in short axis view. Patients were divided into two groups according to BHS presence and values were compared. Results. Basal septal hypertrophy was found in half of the patients (53.6%). The whole cohort had altogether normal LV geometry and global systolic and diastolic function, as well as global indices of radial (GRS 43.86 ± 10.75%) and longitudinal strain (GLS -19.73 ± 2.19%), while global circumferential strain (GCS) was mildly reduced (GCS -19.5 ± 2.81%). BSH patients had more expressed LV geometry changes (LV mass: 89.19±24.59 g/m² vs 109.15±25.33 g/m², p<001; relative wall thickness: 0.3±0.08 vs 0.38±0.11, p<0.001) and have also revealed a specific pattern of longitudinal deformation impairment in three LV segments (basal and mid interventricular septum, basal anteroseptum). A „strain gradient“ from LV base to apex (basal<mid<apical) was observed in the whole population for longitudinal and circumferential strain, and it was more pronounced in the BSH group. This group had more impaired averaged values of six basal LV segments for longitudinal strain and improved circumferential strain averaged for 6 apical segments. Subendocardial longitudinal strain was also more impaired in BSH group. Appearance of BSH, LV remodeling and regional LS impairement correlate with diastolic dysfunction (i.e. impaired relaxation). Conclusion. Appearance of BSH is found to be a macroscopic marker of the regional and global LV remodeling, as well as a marker of diastolic and regional systolic dysfunction of the basal and mid LV segments.

Abstract in Croatian

Uvod. Već je u ranome tijeku arterijska hipertenzija (AH) povezana s pojavom širokog spektra subkliničkih poremećaja geometrije i funkcije lijeve klijetke (LK). Cilj rada. Cilj rada je istražiti da li je pojava hipertrofije interventrikulskog septuma u izgonskom traktu lijeve klijetke (BHS) marker početnih intrinzičnih oštećenja funkcije LK. Metode. U istraživanje je uključeno ukupno 138 bolesnika s primarnom AH mlađih od 65 godina, bez drugih komorbiditeta te s očuvanom istisnom frakcijom lijeve klijetke. Učinjen je kompletni standardizirani transtorakalni pregled, te studija deformacije miokarda metodom speckle tracking-a. Globalna i regionalana uzdužna deformacija analizirana je iz apikalnog četiri-, dvo- i trokomorskog prikaza, prema 18-segmentnom modelu. Vrijednosti globalne i regionalne kružne i poprečne deformacije mjerene su u parasternalnom prikazu kratke osi LK. Ispitanici su podijeljeni u dvije skupine ovisno o prisutnosti BHS, te su izmjerene vrijednosti analizirane i uspoređene. Rezultati. Prisutnost BHS utvrđena je u polovice ispitanika (53.6%). U cijeloj je ispitanoj skupini utvrđena normalna geometrija, kao i sistolička i dijastolička funkcija LK. Vrijednosti globalne uzdužne (GLS -19.73 ± 2.19%) i poprečne (GRS 43.86 ± 10.75%) deformacije su također bile u referentnim granicama, dok je globalna kružna deformacija bila blago reducirana (GCS -19.5 ± 2.81%). Skupina bolesnika s BHS imala je izraženije promjene geometrije LK (masa LK: 89.19±24.59 g/m² vs 109.15±25.33 g/m², p<001; relativna debljina stijenke: 0.3±0.08 vs 0.38±0.11, p<0.001), te je utvrđeno izraženije regionalno oštećenje uzdužne deformacije u tri segmenta (bazalni i srednji segment interventrikulaskog septuma i bazalni segment anteroseptuma). Ustanovili smo postojanje gradijenta uzdužne i kružne deformacije od baze prema apeksu u cijeloj ispitanoj skupini (bazalni<srednji<apikalni segment LK), izraženiji u skupini bolesnika s BHS. U ovih je bolesnike zabilježeno izrazitiije oštećenje uzdužne deformacije u bazalnim segmentima, dok je kružna deformacija u apikalnim segmentima LK bila bolja. Oštećenje subendokardijalne uzdužne deformacije također je bilo izrazitije u BHS skupini. Pojava BHS, remodeliranja i regionalnog oštećenja uzdužne deformacije korelirala je s pojavom oštećenja relaksacije LK. Zaključak. Pojava BHS je makroskopski marker regionalnog i globalnog remodeliranja lijeve klijekte, kao i marker oštećenja dijastoličke i regionalne sistoličke funkcije u bazalnim i srednjim segmentima LK.

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