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Differences in left ventricular functional adaptation to arterial stiffness and neurohormonal activation in patients with hypertension: a study with two-dimensional layer-specific speckle tracking echocardiography

 Darae Kim  ;  Chi Young Shim  ;  corresponding author Geu-Ru Hong  ;  Sungha Park  ;  InJeong Cho  ;  Hyuk-Jae Chang  ;  Jong-Won Ha  ;  Namsik Chung 
 Clinical Hypertension, Vol.23 : 21, 2017 
Journal Title
 Clinical Hypertension 
Issue Date
Aldosterone ; Arterial stiffness ; Left ventricle
Background: Arterial stiffness increases pressure load to the left ventricle (LV), leading to LV hypertrophy and subendocardial ischemia. Neurohormones stimulate myocardial fibrosis and LV dysfunction. We aimed to explore the associations of arterial stiffness and plasma aldosterone with multi-directional, layer-specific LV, and left atrial (LA) mechanical function in hypertensive patients. Methods: Layer-specific LV global longitudinal strain (GLS-trans, GLS-endo, GLS-epi), global circumferential strain (GCS-trans, GCS-endo, GCS-epi), LV torsional parameters, and LA global longitudinal strain (LA GLS) were analyzed by two-dimensional speckle tracking echocardiography in 195 hypertensive patients (110 men, mean age 55 years). Pulse wave velocity (PWV) was analyzed as a measure of arterial stiffness, and plasma aldosterone was measured for evaluation of neurohormonal activation. Results: In a simple correlation, PWV significantly correlated with LV GLS-endo and LA GLS. Log aldosterone correlated with both LV GCS-endo and LV GCS-trans. Multiple regression analysis revealed that LV GLS-endo (β = 0.223, p = 0.031) and LA GLS (β = -0.311, p = 0.002) were independently correlated with PWV even after controlling for confounding factors. Conclusions: In hypertensive patients without clinically apparent target organ damage, LV GLS, especially endocardium, and LA GLS were more dominantly affected by arterial stiffness because, among the three myocardial layers, the endocardium is most susceptible to pressure overload. Two-dimensional layer-specific speckle-tracking echocardiography sensitively detects LV mechanical dysfunction and provides pathophysiologic insights into LV mechanical adaptations in hypertension.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김다래(Kim, Da Rae)
박성하(Park, Sung Ha) ORCID logo https://orcid.org/0000-0001-5362-478X
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정남식(Chung, Nam Sik)
조인정(Cho, In Jeong)
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
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