Assessment of Left Ventricular Torsion in Hypertensive Patients

Abstract

Background: Hypertension has important effects on left ventricle and its early detection helps to avoid the cardiac complications. LV Twist in systole helps in storing potential energy during diastole; LV untwist releases this energy. Speckle tracking echocardiography (STE) is angle-independent so it allows a more detailed evaluation of myocardial deformation. Objective: This work aimed to assess the left ventricular torsion by speckle tracking in hypertensive patients. Patients and Methods: The study was applied on 40 hypertensive patients and 20 age and sex matched control groups; all had speckle tracking echocardiography of the LV, and the basal and apical rotation were measured to assess the LV torsion. The 18 segments of LV strain were assessed and the net LV global longitudinal strain was calculated and demonstrated as bull's eye figure. Results: Hypertensive patients had higher mean values of both apical rotation and left ventricular twist than control group by a highly significant value (9.76 ± 4.98 vs 4.03 ± 2.15, P value < 0.001) and (15.25 ± 4.10 vs 9.90 ± 1.47, P value < 0.001) respectively. Hypertensive patients had a higher basal rotation than controls but did not reach a significant value (−6.01 ± 3.25 vs −5.52 ± 2.63, P value 0.558). On the contrary, the global LV longitudinal strain was lower in hypertensive patients than control but did not reach a significant value (−18.48 ± 3.94 VS −19.48 ± 3.57, P value 0.341). Conclusion: Hypertension affects myocardial structure and its systolic and diastolic functions; the left ventricular twist is an essential component of the systolic function that increases in hypertension as an early compensation for the systolic impairment. The detection of these changes achieved accurately by 2-D speckle tracking, can help in monitoring the treatment modalities of the patients for a better direction of treatment and thus, prevent further deterioration.