Abstract 12402: Noninvasive Evaluation of the Feature of Hypertensive Heart Failure With Preserved and Reduced Ejection Fraction using Three-dimensional Speckle Tracking Echocardiography With High Volume Rate

Background: Left ventricular (LV) systolic and diastolic property in hypertension (HTN) may be deteriorated by pressure overload that causes LV hypertrophy (LVH) and fibrosis, resulting in hypertensive heart failure (HHF). HHF with reduced ejection fraction (HFrEF) or preserved EF (HFpEF) is mainly caused by systolic dysfunction or diastolic dysfunction, respectively. Some of HHF have combined dysfunction and LV torsion may play an important role to maintain systolic performance even in HHF. Methods: We examined 31 controls (age 65±12), 94 HTN (age 69±11), 24 HFpEF (EF≧50%) (age 79±10) and 13 HFrEF (EF<50%) (age 66±13) by one-beat real-time 3-dimensional speckle tracking echocardiography with volume rate of 70-80vps (3D-STE). LV radial strain rate at systole (SR-S) and torsion were assessed as an index that reflects LV contractility. Tau, SR at isovolumic relaxation (SR-IVR) and untorsion rate were assessed as relaxation. Pulmonary capillary wedge pressure (PCWP) was estimated as 10.8 - 12.4 x log {left atrial (LA) active emptying function / LA minimum volume} as we recently reported. Tau was calculated as IVR time / (ln 0.9 x systolic blood pressure - ln PCWP). LV stress was calculated as LV radius x pressure / thickness. LV stiffness was estimated as LV diastolic stress / strain. Results: LVEF in HFpEF was comparable to control and HTN, whereas LV SR-S and torsion were reduced associated with increased systolic stress. LVEF, SR-S and torsion were reduced in HFrEF compared to control. Tau and untorsion rate were deteriorated in HFrEF. LV SR-IVR was deteriorated in only HFpEF. LV stiffness in HFpEF and HFrEF were increased associated with increased diastolic stress (table). Conclusion: Noninvasive 3D-STE examination revealed that LVEF in HFrEF was decreased associated with decreased contractility and increased systolic stress and that LV diastolic function such as LV relaxation and stiffness in HFpEF was deteriorated associated with increased PCWP and diastolic stress. ![][1] [1]: /embed/graphic-1.gif