The Association Between Presystolic Wave and Subclinical Left Ventricular Dysfunction in Asymptomatic Hypertensive Patients: Speckle-Tracking Echocardiographic Study

Yahia, Mohamed; Soliman, Mahmoud; Hashem, Mohamed

doi:10.36660/ijcs.20230201

Brasil

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ORIGINAL ARTICLE • Int J Cardiovasc Sci 37 • 2024 • https://doi.org/10.36660/ijcs.20230201 linkcopy

The Association Between Presystolic Wave and Subclinical Left Ventricular Dysfunction in Asymptomatic Hypertensive Patients: Speckle-Tracking Echocardiographic Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Central Illustration
: The Association Between Presystolic Wave and Subclinical Left Ventricular Dysfunction in Asymptomatic Hypertensive Patients

Abstract

Background Presystolic waves are often found during Doppler evaluation of the left ventricular outflow tract (LVOT) in hypertensive individuals. LV stiffness and altered LV compliance are potential mechanisms for presystolic waves.

Objectives This study's objective was to examine the relationship between presystolic wave and subclinical left ventricular (LV) impairment in asymptomatic individuals with essential hypertension.

Methods This observational research comprised 87 individuals with essential hypertension. All patients had two-dimensional and Doppler echocardiography performed. Based on the existence or absence of a presystolic wave, patients were separated into two groups. Using speckle-tracking echocardiography, subclinical LV systolic impairment was identified. Data were analyzed using IBM SPSS version 20.0. The significance level adopted in the statistical analysis was 5%.

Results The mean age of the studied patients was 51 ± 9 years, with a male percentage of 57.4%. Among them, 57 patients (65%) had a presystolic wave, and 30 (35%) did not. Left ventricular mass index (LVMI) was greater in patients with a presystolic wave in comparison with patients without it (105.8 ± 16.1 g/m² versus 99.8 ± 9.47 g/m², p-value = 0.03). Left atrial volume index (LAVI) was higher in patients with a presystolic wave in comparison with patients without it (28.9 ± 5.25 ml/m² versus 26.3 ± 2.74 ml/m^2, p-value = 0.016). Patients with presystolic wave demonstrated LV diastolic dysfunction more than patients without it (p-value = 0.024). Left ventricular global longitudinal strain (LVGLS) was lower in patients with a presystolic wave in comparison with patients without it (-20.2 ± 2.55 versus -21.7 ± 2.27 % with p-value = 0.008). Patients with presystolic wave demonstrated more subclinical LV systolic dysfunction than patients without it (p-value = 0.025).

Conclusion The presystolic wave was linked to subclinical LV impairment. The existence of a presystolic wave may indicate hypertensive people who are at risk of developing overt heart failure.

Essential Hypertension; Vascular Stiffness; Echocardiography

	Presystolic wave present (n = 57)	Presystolic wave absent (n = 30)	P-value
Age (years)	52.3 ± 8.16	51.1 ± 9.21	0.547
Sex
Male	32 (56.1%)	18 (60.0%)	0.729
Female	25 (43.9%)	12 (40.0%)	0.729
BMI (kg/m²)	31 ± 2.63	30 ± 4.06	0.228
Diabetes mellitus (n., %)	12 (13.8%)	8 (9.2%)	0.611
Dyslipidemia (n., %)	21 (36.8%)	7 (23.3%)	0.200
Smoking (n., %)	19 (33.3%)	9 (30.0%)	0.752
Systolic BP (mmHg)	141.33 ± 13.4	137.67 ± 12.5	0.285
Diastolic BP (mmHg)	86.16 ± 6.4	84 ± 7.6	0.194
Serum creatinine (mg/dl)	1.07 ± 0.29	0.95 ± 0.16	0.38
Total cholesterol (mg/dl)	199 ± 35.3	193.2 ± 33.7	0.367
LDL-C (mg/dl)	131.5 ± 33.5	127.9 ± 33.9	0.461
HDL-C (mg/dl)	38.3 ± 7.1	39.4 ± 6.4	0.941
TG (mg/dl)	142.8 ± 60.4	131.9 ± 34.5	0.469

	Presystolic wave present (n = 57)	Presystolic wave absent (n = 30)	P-value
IVSD (cm)	1.21 ± 0.19	1.18 ± 0.19	0.449
LVEDD (cm)	5.04 ± 0.40	4.94 ± 0.40	0.266
LVESD (cm)	3.09 ± 0.39	3.09 ± 0.33	0.94
LV ejection fraction (%)	62.4 ± 4.90	63.4 ± 4.96	0.347
LVMI (g/m²)	105.8 ± 16.1	99.8 ± 9.47	0.03
Left atrium size (cm)	3.74 ± 0.43	3.48 ± 0.42	0.008
LAVI (ml/m²)	28 (17 – 40)	25.5 (22 – 35)	0.016
TR Velocity (m/s)	2.8 (1.6– 3.86)	2.52 (1.86 – 3.31)	0.003
E (cm/s)	63.8 ± 11.2	79.4 ± 21.4	0.001
A (cm/s)	65.3 ± 12.7	52 ± 10.5	<0.001
E/A ratio	0.9 (0.6 – 2)	1.5 (0.4 – 2.4)	0.002
e' average (cm/s)	8 (5 – 13.5)	13 (9 – 16)	<0.001
E/e'	7.4 (4.4 – 18)	6 (3.7 – 9.4)	<0.001
LV diastolic dysfunction (n., %)	23 (40%)	5 (16.6%)	0.024

	Presystolic wave present (n = 57)	Presystolic wave absent (n = 30)	P-value
Average GLS %	-20.2 ± 2.55	-21.7 ± 2.27	0.008
Subclinical LV systolic dysfunction* (n., %)	18 (31.6%)	3 (10%)	0.025

	Univariate		#Multivariate

	p	OR (LL – UL 95% CI)	p	OR (LL – UL 95% CI)
Left atrium size	0.011	4.024 (1.373 – 11.789)	0.092	3.134 (0.828 – 11.859)
LAVI	0.018	1.145 (1.024 – 1.282)	0.193	1.097 (0.955 – 1.260)
TR Velocity	0.004	5.403 (1.735 – 16.826)	0.048	4.294 (1.015 – 18.164)
E (cm/s)	<0.001	0.940 (0.908 – 0.973)	0.006	0.946 (0.909 – 0.985)
Subclinical LV systolic dysfunction*	0.034	4.154 (1.113 – 15.504)	0.036	4.937 (1.110 – 21.947)

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[TFN1] HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; TG: Triglycerides; CAD: Coronary artery disease; p: p-value for comparing the two studied groups.