الفهرس | Only 14 pages are availabe for public view |
Abstract Arterial hypertension (HTN) remains the greatest attributable risk factor for incident heart failure (HF) especially HF with preserved ejection fraction (HFpEF). Approximately 75–85% of HFpEF cases are linked to hypertension, sharing similar adverse outcomes and acute/chronic symptoms. HFpEF, a complex clinical syndrome, emerges from various factors such as advanced age and concurrent cardiac and extracardiac comorbidities. Its escalating prevalence worldwide has made it a leading cause of morbidity and mortality. The association between hypertension and HFpEF extends beyond conventional factors like left ventricular hypertrophy (LVH) and diastolic dysfunction. It potentially encompasses concurrent systolic dysfunction. However, differentiating between subtle cardiac dysfunctions in hypertensive HFpEF patients and purely hypertensive patients poses challenges due to their similar presentations and myocardial structural changes. Therefore, early identification of subclinical systolic dysfunction among hypertensive subjects might be helpful in differentiating patients at higher risk for the development of HF. Speckle tracking echocardiography (STE) is a new noninvasive method for assessment of global and regional LV function independently of cardiac angle. STE can detect subclinical cardiac dysfunction in hypertensive patients with HFpEF early and sensitively, and the strain parameters obtained by STE are independent predictors of poor prognosis. Among all strain parameters, global Longitudinal strain (GLS) tends to be more useful as longitudinally-orientated inner myocardial fibers are involved in the early stage of hypertensive disease. N-terminal-prohormone brain natriuretic peptide (NT-proBNP) remains a gold standard biomarker in the diagnosis and prognosis of HFpEF, recommended by the current ESC guidelines. It’s is primarily synthesized and released in the ventricle in response to ventricular hemodynamic changes, so its increase in HFpEF acts as a counter-regulatory system and reflects the severity of LV dysfunction. Neither echocardiography nor NT-proBNP alone could be sufficient for HFpEF diagnosis. Hence, a multifaceted approach using a combination of clinical, laboratory, and imaging parameters, as outlined by the HFA– PEFF diagnostic algorithm recommended by recent ESC guidelines, becomes crucial for accurate diagnosis or exclusion of HFpEF. Our study was conducted at cardiovascular department at Menoufia and Tanta University hospitals, included 62 hypertensive patients with preserved EF (patients group) and 62 healthy controls (control group). Then HFA-PEFF score for HFpEF diagnosis, approved by recent ESC guidelines, was used to differentiate hypertensive patients who developed HFpEF from those with pure HTN. |