Cardiac mechanics in mild hypertensive heart disease: a speckle-strain imaging study

Arumugam Narayanan, Gerard P Aurigemma, Marcello Chinali, Jeffrey C Hill, Theo E Meyer, Dennis A Tighe
Circulation. Cardiovascular Imaging 2009, 2 (5): 382-90

BACKGROUND: We hypothesized that abnormalities in regional systolic strain (epsilon) might be present among hypertensive subjects with normal ejection fraction, and, if present, could be used to identify patients at high risk for heart failure. The aim of the current case-control study was to use speckle tracking imaging to identify subclinical global and regional systolic function abnormalities in hypertensive subjects with normal ejection fraction.

METHODS AND RESULTS: Standard 2D Doppler echocardiography, tissue Doppler imaging, and 2D speckle strain imaging were performed in 52 hypertensive subjects with normal ejection fraction and 52 control subjects of similar age. Peak systolic (S'), and diastolic (E') annular velocities were obtained by tissue Doppler imaging, whereas longitudinal myocardial systolic velocity (V(l)) and circumferential, longitudinal, and radial strains (epsilon(c), epsilon(l), epsilon(r)) were obtained by speckle tracking. Midwall shortening and peak basal longitudinal strain (epsilon(l)) were used as indices of regional function. Hypertensive subjects had lower velocities--tissue Doppler imaging E' and S', and V(l)--and evidence of reduced regional function. Surprisingly, however, global epsilon values did not differentiate hypertensive subjects from control subjects. Among hypertensive patients, significant inverse associations were found between left ventricular mass and global longitudinal and circumferential epsilon (both P<0.05).

CONCLUSIONS: Hypertensive heart disease with normal ejection fraction is associated with reduced myocardial velocities and reduced regional function but normal global epsilon. Our data suggest that velocity abnormalities occur early in hypertension and may be an appropriate target for preventive strategies because they occur before abnormalities in global epsilon.

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