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The relationship between left ventricular deformation and different geometric patterns according to the updated classification

findings from the hypertensive population

Tadic, Marijanaa , b; Cuspidi, Cesarec; Majstorovic, Ankaa; Kocijancic, Vesnaa; Celic, Veraa , b

doi: 10.1097/HJH.0000000000000618

Objective: We sought to investigate left ventricular mechanics in hypertensive patients with different geometric patterns by using two-dimensional (2DE) and three-dimensional (3DE) strain analysis.

Methods: This cross-sectional study included 197 hypertensive individuals who underwent a complete 2DE and 3DE examination. We applied the new updated criteria of left ventricular geometry that considered left ventricular mass index, left ventricular end-diastolic diameter and relative wall thickness. According to this classification the individuals were divided into six groups: normal geometry, concentric remodelling, eccentric nondilated left ventricular hypertrophy (LVH), concentric LVH, dilated LVH and concentric-dilated LVH.

Results: Multidirectional 2DE and 3DE left ventricular strain decreased from the hypertensive patients with normal geometry, across the individuals with left ventricular concentric remodelling, eccentric nondilated LVH, to the patients with concentric LVH and dilated LVH patterns. The reduction of left ventricular systolic and early diastolic strain rates was noticed to be heading in the same direction, as well as the elevation of late diastolic strain rates. Left ventricular twist and torsion were increased in the participants with concentric and dilated LVH patterns. Reduced 2DE and 3DE strains were associated with concentric and dilated LVH patterns independent of demographic and clinical parameters.

Conclusion: Left ventricular deformation in hypertensive patients is significantly impacted by left ventricular geometry. Concentric and dilated LVH patterns have the greatest unfavourable effect on 2DE and 3DE left ventricular mechanics. The updated classification of left ventricular geometry provides valuable and comprehensive information about left ventricular mechanical deformation and function in hypertensive population.

aUniversity Clinical Hospital Center ‘Dr Dragisa Misovic - Dedinje’, Cardiology Department

bFaculty of Medicine, Belgrade, Serbia

cUniversity of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy

Correspondence to Marijana Tadic, MD, PhD, University Clinical Hospital Center ‘Dr Dragisa Misovic - Dedinje’, Heroja Milana Tepica 1, Belgrade 11000, Serbia. E-mail:

Abbreviations: 2DE, two-dimensional echocardiography; 3DE, three-dimensional echocardiography; A, late diastolic mitral flow obtained by pulsed Doppler; BP, blood pressure; BSA, body surface area; E, early diastolic mitral flow obtained by pulsed Doppler; e′, average of the peak early diastolic relaxation velocity of the septal and lateral mitral annulus assessed by tissue Doppler; IVS, interventricular septum; LV, left ventricle; LVH, left ventricular hypertrophy; LVIDd, left ventricular internal end-diastolic diameter; LVMI, left ventricular mass index; PWT, posterior wall thickness; RWT, relative wall thickness

Received 25 January, 2015

Revised 24 March, 2015

Accepted 30 March, 2015

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