الفهرس 
HypertensionOnly 14 pages are availabe for public view
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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.