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Does a nondipping pattern influence left ventricular and left atrial mechanics in hypertensive patients?

Tadic, Marijanaa; Cuspidi, Cesareb; Majstorovic, Ankaa; Sljivic, Aleksandraa; Pencic, Biljanaa; Ivanovic, Branislavac,d; Scepanovic, Radisava,d; Kocijancic, Vesnaa; Celic, Veraa,d

doi: 10.1097/HJH.0b013e3283651c24

Objective: The aim of this study was to determine left ventricular and left atrial function in untreated hypertensive patients with different blood pressure (BP) patterns by using two-dimensional echocardiography (2DE) and three-dimensional echocardiography (3DE) speckle tracking analyses.

Methods: This cross-sectional study included 147 recently diagnosed hypertensive patients (86 dippers and 61 nondippers). All patients underwent a 24-h ambulatory BP monitoring and complete 2DE and 3DE examination including speckle tracking analysis.

Results: The analysis of our results showed that 3DE left ventricular global longitudinal strain was significantly lower in the nondippers (−17.8 ± 2.6 vs. −16.2 ± 2.4%, P < 0.001). Similar results were obtained for 3DE left ventricular global circumferential strain (−17.4 ± 2.7 vs. −16.3 ± 2.6%, P = 0.015), as well for 3DE left ventricular global radial strain (45.8 ± 8.5 vs. 42.1 ± 8.2%, P = 0.009), and left ventricular global area strain (−29.1 ± 4.7 vs. −27.4 ± 4.3%, P = 0.027). The left ventricular twist was increased in the nondippers (12.7 ± 2.9 vs. 14.1 ± 3.4°, P = 0.008), whereas the untwisting rate was significantly decreased in this group (−43.7 ± 5.7 vs. −36.9 ± 5.1 °/s, P < 0.001). The left atrial longitudinal strain, as well as left atrial systolic and early diastolic strain rates, was decreased in nondippers. Independent predictors of 3DE left ventricular longitudinal, circumferential, radial, and area strain were a 24-h mean BP, (E/e′)m, and 3DE left ventricular ejection fraction. An additional independent predictor of the left atrial longitudinal strain was 3DE left ventricular mass index.

Conclusion: The 3DE speckle tracking examination demonstrated that the left ventricular and left atrial mechanics were more impaired in the nondippers than in the dippers untreated hypertensive patients.

aUniversity Clinical Hospital Center ‘Dr Dragisa Misovic’, Belgrade, Serbia

bClinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy

cClinic of Cardiology, Clinical Centre of Serbia

dFaculty of Medicine, University Clinical Hospital Center ‘Dr Dragisa Misovic’, Belgrade, Serbia

Correspondence to Associate Professor Vera Celic, University Clinical Hospital Center ‘Dr Dragisa Misovic’, Heroja Milana Tepica 1, 11000 Belgrade, Serbia. Tel: +381 11 3630600; fax: +381 11 3672025; e-mail:

Abbreviations: 2DE, two-dimensional echocardiography; 3DE, three-dimensional echocardiography; A m, late diastolic mitral flow (pulse Doppler); BP, blood pressure; CO, cardiac output; DT, deceleration time; e′, early diastolic flow velocity across the septal segment of mitral (em) annulus (tissue Doppler); E m, early diastolic mitral flow (pulse Doppler); GAS, global area strain; GCS, global circumferential strain; GLS, global longitudinal strain; GRS, global radial strain; HTA, hypertension; LV, left ventricle; LVM, left ventricular mass; MAP, mean arterial pressure; SV, stroke volume

Received 18 April, 2013

Revised 1 July, 2013

Accepted 15 July, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins