Fu Ming, Hu Xiangming, Sun Shuo, Yi Shixin, Zhang Ying, Feng Yingqing, Zhou Yingling, Geng Qingshan, Dong Haojian
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.; Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.
Int J Gen Med. 2021 May 25;14:2053-2061. doi: 10.2147/IJGM.S310414. eCollection 2021.
Masked hypertension (MHT), as an independent clinical entity, the cardiac dysfunction caused by it can be early detected through left ventricular global longitudinal strain (GLS), yet the quantitative relation between MHT and GLS is still unclear. Therefore, we tried to conduct a community-based retrospective study to define this relationship.
A total of 308 enrolled participants from Dongguan, China, were divided into non-hypertension (NHT) and MHT groups. Baseline characteristics were recorded, and echocardiography and 24-hour ambulatory blood pressure monitoring were performed. Linear regression analysis and receiver-operating characteristic (ROC) curve analysis were used to assess the associations between MHT and GLS in univariate and multivariate models, and the dose-response curve was plotted to demonstrate their relationship.
The mean age of the NHT and MHT groups was 57 and 60 years, respectively. Signs of left ventricular diastolic function, E/A was reduced and E/e' was increased in the MHT group while those of the NHT group were nearly normal. The MHT group also showed a significantly lower ("worse") GLS than NHT (-15.2% vs -19.9%, P < 0.001) while left ventricular ejection fraction (LVEF) did not differ between the groups. Worse GLS was independently and significantly associated with MHT both in univariate (odds ratio [OR]: 1.97, P < 0.001) and stepwise multivariate regression analysis (OR: 1.99, P < 0.001). Comparison of ROC curve results showed that area under curve of GLS was larger than that of E/e' both in unadjusted (0.8673 vs 0.6831) and adjusted model (0.9178 vs 0.8284). Further analysis showed adjusted nonlinear correlation between MHT and GLS.
Based on the relationship between MHT and GLS, in clinical practice, GLS measurement could facilitate diagnosis for suspected MHT patients and could define the extent of left ventricular dysfunction for diagnosed MHT patients.
隐匿性高血压（MHT）作为一种独立的临床实体，其所致的心脏功能障碍可通过左心室整体纵向应变（GLS）早期检测出来，但MHT与GLS之间的定量关系仍不清楚。因此，我们试图开展一项基于社区的回顾性研究来明确这种关系。
总共308名来自中国东莞的入选参与者被分为非高血压（NHT）组和MHT组。记录基线特征，并进行超声心动图检查和24小时动态血压监测。采用线性回归分析和受试者操作特征（ROC）曲线分析在单变量和多变量模型中评估MHT与GLS之间的关联，并绘制剂量反应曲线以阐明它们之间的关系。
NHT组和MHT组的平均年龄分别为57岁和60岁。MHT组出现左心室舒张功能异常体征，E/A降低、E/e'升高，而NHT组的这些指标接近正常。MHT组的GLS也显著低于（“更差”）NHT组（-15.2%对-19.9%，P<0.001），而两组之间的左心室射血分数（LVEF）无差异。在单变量（优势比[OR]：1.97，P<0.001）和逐步多变量回归分析（OR：1.99，P<0.001）中，更差的GLS均与MHT独立且显著相关。ROC曲线结果比较显示。在未调整模型（0.8673对0.6831）和调整模型（0.9178对0.8284）中，GLS的曲线下面积均大于E/e'。进一步分析显示MHT与GLS之间存在调整后的非线性相关性。
基于MHT与GLS之间的关系，在临床实践中，测量GLS有助于疑似MHT患者的诊断，并可为已确诊的MHT患者明确左心室功能障碍的程度。
