V.M. Kovalenko, E.G. Nesukay, E.Yu. Titov, N.S. Polenova, O.O. Danylenko. Optimization of the diagnosis of heart failure with preserved left ventricular ejection fraction in patients with essential hypertension using speckle-tracking echocardiography

The aim – to study strain and strain rate of left ventricular (LV) and left atrium (LA) at rest and during exercise and establish early markers and mechanisms of heart failure (HF) with preserved ejection fraction (EF) in patients with essential hypertension (EH).

Material and methods. The study involved 30 patients with EH (men – 60 %) aged (55.5±2.8) years. Patients with EH and HF with preserved LVEF (15 patients) constituted group 1. The group 2 included 15 patients with EH and without HF. All patients were studied by means of echocardiography, stress echocardiography and speckle tracking echocardiography, as well as measuring NT-proBNP levels.

Results. Patients of group 1 had significantly higher LV mass index (at 22.5 %), LA volume index (at 29.2 %), level of NT-proBNP (2.3 times) and LV filling pressure, compared to group 2. Group 1 showed also significant decrease of mean longitudinal and circumferential LV systolic strain (22.7 and 26.9 % respectively), indices of LV and LA diastolic strain as well as LA conduit, reservoir and contractile function. The factors associated with HF with preserved LVEF in patients of group 1 were established: the value of LA systolic strain < 27.5 %, value of LV global systolic longitudinal strain < 10 % and early LV diastolic strain rate < 0.47 c–1. During exercise there was no increase in LV longitudinal systolic and diastolic strain, no improvement of the reservoir and conduit LA function in group 1. This was accompanied by increasing LV filling pressure and appearance of dyspnea, compared to patients of group 2. Conclusions. Patients with hypertension and HF with preserved LVEF have more pronounced impairment of LV and LA strain compared to patients with EH without HF. Echocardiographic parameters associated with HF with preserved LVEF in patients with EH were identified. We found link between reduced exercise tolerance and LV/LA strain abnormalities in patients with EH and HF with preserved LVEF.

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