Deformation of the left heart chambers in hypertensive postmenopausal women, depending on the presence of left ventricular hypertrophy and left atrium dilation
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Abstract
The aim – to assess the longitudinal deformation (strain) of the left heart chambers in postmenopausal women with essential hypertension (EH), depending on the presence of left ventricular hypertrophy (LVH) and left atrial (LA) dilation.
Materials and methods. The study involved 126 postmenopausal women: 100 patients with EH I–II stages of the main group and 26 practically healthy women of the comparison group. Patients with EH were divided into two groups:
32 patients without structural changes of the myocardium and 68 women with LVH and/or LA dilation. In all patients we performed ambulatory blood pressure monitoring, standard transthoracic echocardiography and speckle-tracking echocardiography. The global longitudinal strain (GLS) of LV and deformation of the endocardial (endo), middle (mid) and epicardial (epi) layers of myocardium were analyzed. Analysis of LA deformation was performed using two (from the beginning of the R-wave and from the apex of the R-wave) variants of ECG-synchronization. The LA longitudinal strain (LS) was evaluated in reservoir and contraction phase in two positions with the calculation of the GLS LA.
Results and discussion. We found changes in LV multilayer deformation as LS decreasing in the endocardial, middle and epicardial layers in hypertensive patients in the early stages of disease, even before the development of LVH. Damage of LA deformation preceded its dilation. Both types of ECG-synchronization showed a statistically significant decrease of LA strain in the reservoir phase in all hypertensive patients in comparison with healthy women. A decreasing LA GLS in women with EH and structurally normal heart compared to the healthy group was detected only by using ECG-synchronization with R-wave, which is considered more universal.
Conclusion. A decrease of LA and LV LS in postmenopausal women is recorded even before the development of LVH and LA dilation. The LV LS became lower in all layers of myocardium – from endocardial to epicardial. Changes in the LA LS in postmenopausal women with EH begin with a damage of reservoir phase even with normal size of LA and a LV myocardial mass index.
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