Effects of non-dipper blood pressure pattern on left ventricular rotational mechanics in hypertensive patients with type 2 diabetes mellitus: a speckle tracking study

• Published in: The International Journal of Cardiovascular Imaging Vol. 30; no. 1; pp. 57 - 65
• Main Authors: Gökdeniz, Tayyar, Kalaycıoğlu, Ezgi, Aykan, Ahmet Çağrı, Gül, İlker, Boyacı, Faruk, Gürsoy, Mustafa Ozan
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 2014; Springer Nature B.V
• Subjects: Aged; Biomechanical Phenomena; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiac Imaging; Cardiology; Chi-Square Distribution; Circadian Rhythm; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - complications; Echocardiography, Doppler, Pulsed; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension - diagnostic imaging; Hypertension - physiopathology; Imaging; Linear Models; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Original Paper; Predictive Value of Tests; Radiology; Reproducibility of Results; Stroke Volume; Systole; Time Factors; Torsion, Mechanical; Ventricular Function, Left; Type 2 diabetes mellitus; Left ventricle rotational mechanics; Non-dipper blood pressure pattern; Two-dimensional speckle tracking echocardiography; Ambulatory blood pressure monitoring
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-013-0296-5

We aimed to evaluate the effects of non-dipper BP pattern on left ventricular (LV) rotational mechanics in hypertensive patients with type 2 diabetes mellitus (T2DM) with the utility of two-dimensional speckle tracking echocardiography (2D-STE). Eighty-six hypertensive patients with T2DM were enrolled. All patients underwent 2D-echocardiography and 24-h-ambulatory blood pressure monitoring. Fifty-nine (59.3 %) patients had non-dipper BP pattern and all subjects had normal LV function. Patients with non-dipper BP pattern had decreased systolic tissue velocity ( p : 0.006), increased peak systolic apical rotation and rotation rate ( p : 0.008 and p : 0.014, respectively), and peak LV twist and twist rate ( p : 0.005 and p : 0.012, respectively). Analysis of LV diastolic parameters showed that, early diastolic tissue velocity (Em) was decreased and E/Em ratio and LV mass (LVM) index were increased in non-dipper group while the time to LV untwisting rate was delayed. In multivariate analysis, peak LV twist (β = 0.459, p : < 0.001) and twist rate (β = 0.388, p : 0.001) were independently associated with the difference between mean arterial pressure (MAP)-asleep and MAP-awake. In correlation analysis adjusted for age, sex and LVM index, the time to LV untwisting rate was positively correlated with the difference between MAP-asleep and MAP-awake (r: 0.290 vs. p : 0.008) and E/Em ratio (r: 0.280 vs. p : 0.010). LV rotational mechanics are impaired in T2DM non-dipper hypertensive patients, indicating LV systolic and diastolic dysfunction. 2D-STE may permit better understanding of the underlying pathophysiology and development of preventive strategies.