The Predictive Role of StrainParameters in Predicting All-Cause Mortality in Diabetic Hypertensive Patients with Normal Left Ventricular Systolic Function in Long-Term Follow-up

Yıl 2025, Cilt: 15 Sayı: 1, 30 - 39, 27.03.2025

Ahmet Özderya , Ender Emre , Ezgi Kalaycıoğlu , Murat Gökhan Yerlikaya , Tayyar Gökdeniz , Müjdat Aktaş , Turhan Turan , Mustafa Çetin

https://doi.org/10.31832/smj.1596973

Öz

Objective: To demonstrate the relationship of all-cause mortality in the long term and speckle-tracking echocardiography parameters in a cohort of diabetic hypertensive cases that had preserved left ventricle ejection fraction (LV-EF).
Methods: The study included 141 diabetic hypertensive cases with preserved LV-EF were retrospectively analyzed. After applying exclusion criteria, 121 patients were included. Two groups were formed according to out-of-hospital mortality status. Laboratory and echocardiography data were analyzed.
Results: The mean age of the 121 patients was 58.48.04 years, and the median follow-up duration was 10.08 years. Echocardiographic left atrial strain parameters, namely left atrium reservoir phase strain (35.7±8.7 vs 29.8±7.3, p-value: 0.047), left atrium conduit phase strain (LAScd%) (17.6±5.8 vs 13.3±4.1, p-value: 0.028), and left atrium reservoir phase peak strain (1.5±0.4 vs 1.22±0.3, p-value: 0.037), were worse in the mortality group. In right ventricular strain evaluation, four-chamber right ventricular strain (RV4CSL%) (26.1±5.4 vs. 20.8±6.2, p-value: 0.005) was also worse in the mortality group. Multivariate analysis revealed that the mean daytime systolic blood pressure (odds ratio [OR]: 1.769, p-value: 0.028), LAScd% (OR: 0.820, p-value: 0.015), RV4CSL% (OR: 0.078, p-value: 0.043) independently predicted mortality. Kaplan-Meier analysis showed that LAScd%≤15.3 and RV4CSL%≤24.8 were predictive of mortality (p-values: 0.023 and 0.016, respectively).
Conclusion: Strain parameters, assessed via echocardiography, can be useful diagnostic and follow-up tools for determining prognosis and guiding early risk factor management in diabetic hypertensive patients, especially in comparison to traditional volumetric parameters.

Anahtar Kelimeler

Hypertension, Diabetes mellitus, Strain parameters, Preserved ejection fraction, Mortality

Etik Beyan

The study was performed in accordance with the ethical considerations of the Helsinki Declarations. The study was approved by the ethics committee of SBÜ Trabzon Medicine Faculty, with decision number 31.05.2023/10496660-27

Korunmuş Sol Ventrikül Sistolik Fonksiyonuna Sahip Diyabetik Hipertansif Hastalarda Uzun Dönem Takipte Tüm Nedenlere Bağlı Mortaliteyi Tahmin Etmede Strain Parametrelerinin Rolü

Öz

Amaç: Korunmuş sol ventrikül ejeksiyon fraksiyonu (SoV-EF) olan diyabetik hipertansif vaka kohortunda uzun vadede tüm nedenlere bağlı mortalite ile benek izleme ekokardiyografi parametreleri arasındaki ilişkiyi göstermek.
Gereç ve yöntemler: Çalışmaya, korunmuş SoV-EF'li 141 diyabetik hipertansif vaka dahil edildi ve retrospektif olarak analiz edildi. Dışlama kriterleri uygulandıktan sonra 121 hasta çalışmaya dahil edildi. Hastane dışı mortalite durumuna göre iki grup oluşturuldu. Laboratuvar ve ekokardiyografi verileri analiz edildi.
Bulgular: 121 hastanın ortalama yaşı 58,4±8,04 yıl ve medyan takip süresi 10,08 yıldı. Mortalite grubunda yaş(57,2±7,7 vs. 64,2±6,9 yıl, p değeri:<0,001), diabetes mellitus süresi (6,4±5,1 vs. 9,2±7,2 yıl, p değeri:0,041) ve hipertansiyon süresi (6,48±5,1 vs. 10,5±9,1 yıl, p değeri: 0,003) açısından istatistiksel olarak daha yüksek değerler saptandı. Ekokardiyografik sol atriyum strain parametreleri, yani sol atriyum rezervuar faz strain(35,7±8,7 - 29,8±7,3, p değeri: 0,047), sol atriyum kondüit faz strain(LAScd%)(17,6±5,8 - 13,3±4,1, p değeri: 0,028) ve sol atriyum rezervuar faz pik strain(1,5±0,4 - 1,22±0,3, p değeri: 0,037), mortalite grubunda daha kötüydü. Sağ ventrikül strain değerlendirmesinde, dört odacıklı sağ ventrikül strain (RV4CSL%)(26,1±5,4 - 20,8±6,2, p değeri:0,005) de mortalite grubunda daha kötüydü. Çok değişkenli analiz, ortalama gündüz sistolik kan basıncının (olasılık oranı [OR]: 1,769, p değeri: 0,028), LAScd%'nin(OR: 0,820, p değeri: 0,015), RV4CSL%'nin (OR: 0,078, p değeri: 0,043) mortaliteyi bağımsız olarak öngördüğünü ortaya koydu. Kaplan-Meier analizi, LAScd%≤15,3 ve RV4CSL%≤24,8'in mortaliteyi öngördüğünü gösterdi (sırasıyla p değerleri: 0,023 ve 0,016).
Sonuç: Ekokardiyografi ile değerlendirilen strain parametreleri, özellikle geleneksel hacimsel parametrelerle karşılaştırıldığında, diyabetik hipertansif hastalarda prognozu belirlemek ve erken risk faktörü yönetimine rehberlik etmek için yararlı tanı ve takip araçları olabilir.

Anahtar Kelimeler

Hipertansiyon, Diabetes mellitus, Strain parametreleri, Korunmuş ejeksiyon fraksiyonu, Mortalite

Etik Beyan

Çalışmamız Sağlık Bilimleri Üniversitesi Trabzon Tıp Fakültesi Etik Kurulunda değerlendirilmiş ve 31.05.2023 tarihli 104996660-27 sayılı dosya numaralı karar ile onaylanmıştır. Biz yazarlar olarak da hem etik kurulda bahsedilen kriterlerde hem helsinki bildirgesine uygun olarak çalıştığımızı beyan ederiz.

Kaynakça

• Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103:137–49.
• Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-81.
• Ritchie RH, Abel ED. Basic Mechanisms of Diabetic Heart Disease. Circ Res. 2020;126(11):1501-5.
• Santos ABS, Foppa M, Bertoluci C, Branchi TV, Fuchs SC, Fuchs FD. Stage I hypertension is associated with impaired systolic function by strain imaging compared with prehypertension: A report from the prever study. J Clin Hypertens. 2019;21(10):1705-10.
• Alsharari R, Oxborough D, Lip GYH, Shantsila A. Myocardial Strain Imaging in Resistant Hypertension. Curr Hypertens Rep. 2021 May 5;23(5):24.
• Kalaycıoğlu E, Gökdeniz T, Aykan AÇ, Hatem E, Gürsoy OM, Çavuşoğlu G, et al. Ambulatory arterial stiffness index is associated with impaired left atrial mechanical functions in hypertensive diabetic patients: A speckle tracking study. Anatol J Cardiol. 2015;15(10):807-13.
• Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the american society of echocardiography and the european association of cardiovascular imaging. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography. 2015;28:1-39.e14.
• Shahbaz AU, Sun Y, Bhattacharya SK, Ahokas RA, Gerling IC, McGee JE, et al. Fibrosis in hypertensive heart disease: Molecular pathways and cardioprotective strategies. J Hypertens. 2010 Sep;28 Suppl 1(Suppl 1):S25-32.
• Kang SJ, Lim HS, Choi BJ, Choi SY, Hwang GS, Yoon MH, et al. Longitudinal strain and torsion assessed by two-dimensional speckle tracking correlate with the serum level of tissue inhibitor of matrix metalloproteinase-1, a marker of myocardial fibrosis, in patients with hypertension. J Am Soc Echocardiogr. 2008 Aug;21(8):907-11.
• Gupta S, Matulevicius SA, Ayers CR, Berry JD, Patel PC, Markham DW, et al. Left atrial structure and function and clinical outcomes in the general population. Eur Heart J. 2013 Jan;34(4):278-85.
• Hoit BD. Left atrial size and function: Role in prognosis. J Am Coll Cardiol. 2014;63(6):493-505.
• Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S, et al. Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol. 2012;110(2):264-9.
• Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, et al. Early detection of left atrial strain abnormalities by speckletracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr. 2011;24:898-908.
• Marwick TH. Measurement of strain and strain rate by echocardiography: Ready for prime time? J Am Coll Cardiol. 2006 Apr 4;47(7):1313-27.
• Buggey J, Hoit BD. Left atrial strain: Measurement and clinical application. Curr Opin Cardiol. 2018 Sep;33(5):479-85.
• Modin D, Biering-Sørensen SR, Møgelvang R, Alhakak AS, Jensen JS, Biering-Sørensen T. Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J Cardiovasc Imaging. 2019;20(7):804-15.
• Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R. Anatomy, Function, and Dysfunction of the Right Ventricle: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(12):1463-82.
• Smolarek D, Gruchała M, Sobiczewski W. Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach. Cardiol J. 2017;24(5):563-72.
• Lejeune S, Roy C, Ciocea V, Slimani A, de Meester C, Amzulescu M, et al. Right ventricular global longitudinal strain and outcomes in heart failure with preserved ejection fraction. J Am Soc Echocardiogr. 2020;33(8):973-84.