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BACKGROUND: Patients with hypertension complicated by acute myocardial infarction (AMI) have a generally poor prognosis. The identification of powerful predictors for recurring cardiovascular events (RCEs) is vital. This study seeks to evaluate the predictive value of three-dimensional (3D) strain parameters for RCEs in patients with hypertension complicated by AMI. METHODS: We successfully followed up patients with hypertension and AMI from April 2015 to December 2015 in this retrospective study. Participants previously underwent 3D echocardiography, one week, and one month after percutaneous coronary intervention (PCI). The left ventricular structural function parameters, as well as 3D strain parameters including 3D global longitudinal strain (3D-GLS), 3D global circumferential strain, 3D global radial strain, and 3D global area strain (3D-GAS), were acquired. A Cox model was used to determine the relationships between these parameters and RCEs. RESULTS: In total, 62 patients were enrolled in the analysis. During follow-up (41.27 ± 20.45 months), 20 patients (32.3%) had RCEs that were independently predicted one month after PCI by 3D-GLS (HR: 1.481, 95% CI: 1.202-1.824, P < 0.001) and 3D-GAS (HR: 1.254, 95% CI: 1.093-1.440, P = 0.001). The optimal cutoffs for 3D-GLS and 3D-GAS in predicting cardiac events were ≥12.5% (area under the receiver operating characteristic curve [AUC]: 0.736, 95% CI: 0.611-0.862, P = 0.003), and >20.5% (AUC: 0.685, 95% CI: 0.551-0.818, P = 0.020), respectively. CONCLUSION: The assessed values of 3D-GLS and 3D-GAS one month after PCI can predict RCEs in patients with hypertension complicated by AMI.
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BACKGROUND: A lower systolic blood pressure (SBP) target reduces major cardiovascular events and mortality from any cause of geriatric hypertension. However, the effect of different SBP targets on myocardial function remains unclear. This study aimed to determine changes in left ventricular (LV) strain in older hypertensive patients after 1 year of different SBP goals, and to evaluate its effects on myocardial mechanics in this population. METHODS: We studied 313 hypertensive adults aged 60 years or older after 1 year of the Systolic Blood Pressure Intervention Trial. They were divided into the intensive group (target SBP: 110-130 mmHg) and the standard group (target SBP: 130-150 mmHg). All participants underwent echocardiography within 1 week after enrollment and 1 year after participating in the study. Global longitudinal strain (GLS) of the LV (endocardial, middle, and epicardial layer: GLS-end, GLS-mid, and GLS-epi, respectively) and the improvement of GLS at 1 year (ΔGLS-end, ΔGLS-mid, and ΔGLS-epi) were measured. RESULTS: At 1 year, GLS-end in the intensive group was slightly improved compared with that before the trial (-23.78%±3.10% vs -22.58%±3.11%, P<0.05). The ΔGLS-end and ΔGLS-mid in the intensive group were higher than those in the standard group (1.20±0.23 vs 0.58±0.59% and 0.70±0.21 vs 0.52±0.17, P<0.05). Moreover, SBP at 1 year and an angiotensin II type 1 receptor antagonist were independent factors that affected ΔGLS-end (ß= -0.005, P=0.004; ß= 0.080, P<0.001, respectively). CONCLUSION: These trial results suggest that a lower SBP target can slightly improve myocardial function in older hypertensive patients at 1 year.
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OBJECTIVE: Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal resilience. The purpose of this study is to determine the factors influencing renal resilience in patients with diabetic nephropathy (DN). METHODS: We recruited 56 healthy volunteers and 187 patients with DN. All the participants were evaluated using shear-wave elastography (SWE), and the size of their kidneys and Young's modulus values for the parenchyma were recorded. A total of 187 patients with DN are allocated to three groups according to their urinary albumin-to-creatinine ratio: normoalbuminuric (<30 mg/g creatinine), microalbuminuric (30-300 mg/g), and macroalbuminuric (≥300 mg/g) groups. Renal resilience is compared between the stages of diabetic nephropathy and the healthy control group, and the factors affecting the stiffiness of the renal parenchyma in DN are analyzed. RESULTS: The renal parenchyma is harder in participants with DN than in healthy participants (P < 0.001), and the stiffiness increases with the progression of the disease (P < 0.001). Multivariate logistic regression analysis shows that disease stage (ß = 0.789, P < 0.001), duration of diabetes (ß = 0.028, P < 0.001), and serum creatinine (SCr) concentration (ß = 0.001, p < 0.001) influence the stiffiness of the renal parenchyma. CONCLUSION: We show that SWE can be used to measure changes in the stiffiness of the renal parenchyma in patients with DN. Furthermore, Young's modulus of the renal parenchyma is related to the duration of diabetes, urinary albumin excretion, and SCr concentration. Thus, SWE can be used to objectively and non-invasively stage DN.
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Objectives: This study aimed to quantify left ventricular (LV) myocardial strain and torsion in patients with type 2 diabetes mellitus (T2DM) and evaluate their systolic and diastolic function using conventional and speckle tracking echocardiography. Methods: Forty-seven patients with T2DM were divided into a group without microvascular complications (the DM A group) and a group with microvascular complications (the DM B group), while another 27 healthy participants acted as the control group. All the participants had had an echocardiography examination. All the original data were imported into EchoPAC workstation for the analysis and quantification of LV strain and torsion. Results: Compared with the control group, the LV end-diastolic volume, end-systolic volume, and ejection fraction of the DM A and DM B groups showed no significant differences, but the global longitudinal strain and the global circular strain were reduced in the DM B group. There were significant differences in the left ventricular relative wall thickness (RWT), left ventricular mass index (LVMI), the early mitral valvular blood flow velocity peak/left ventricular sidewall mitral annulus late peak velocity, left ventricular sidewall mitral annulus early peak velocity/left ventricular sidewall mitral annulus late peak velocity, isovolumic relaxation time, peak twisting, peak untwisting velocity (PUV), untwisting rate (UntwR), time peak twisting velocity (TPTV), and time peak untwisting velocity (TPUV) between the DM A, DM B, and control groups. While the peak twisting velocity (PTV) was slower in the DM B group compared with the control group, the RWT, PTV, PUV, UntwR, TPTV, and TPUV in the DM B group were significantly different from the DM A group. Conclusion: The cardiac function of patients with T2DM in its early stages, when there are no microvascular complications, could be monitored with the analysis of two-dimensional strain and torsion.
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Left ventricular (LV) function undergoes subtle changes (subclinical left ventricular dysfunction) in a large proportion of patients with type 2 diabetes (T2DM) who develop diabetic cardiomyopathy. This study aimed to quantify LV myocardial strain and synchrony in T2DM by real-time three-dimensional echocardiography (RT-3DE), and to evaluate subclinical LV dysfunction in T2DM at different glycemic control levels. Seventy-two patients with T2DM with an LV ejection fraction (LVEF) ≥ 55% and 45 healthy individuals as controls who underwent RT-3DE were studied. Patients were also subdivided into the DMa group (glycosylated hemoglobin < 7%, n = 38) and the DMb group (glycosylated hemoglobin ≥ 7%, n = 34). Three-dimensional strain and synchronization parameters of the left ventricle were measured by RT-3DE and compared among the three groups. Despite a similar LVEF, global longitudinal strain (GLS), global circumferential strain (GCS), and global area strain (GAS) in the DMb group were lower, and the standard deviation of peak time (Tm-SD) and the maximum difference in peak time (Tm-Dif) in the DMb group higher, than those in the control and DMa groups (all p < 0.05). Multivariable linear regression analysis showed that the duration of diabetes was independently associated with GCS (ß = - 0.516, p < 0.001) and GAS (ß = - 0.391, p = 0.005). HbA1c levels were independently associated with GLS (ß = - 0.675, p < 0.001), Tm-SD (ß = 3.363, p < 0.001), and Tm-Dif (ß = 3.895, p < 0.001). RT-3DE can detect subclinical myocardial dysfunction in poor glycemic control of T2DM, and myocardial dysfunction is associated with the duration of diabetes and HbA1c.
