Cardiac Mechanics in Mild Hypertensive Heart Disease

Abstract

Background-We hypothesized that abnormalities in regional systolic strain () 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 (SЈ), and diastolic (EЈ) annular velocities were obtained by tissue Doppler imaging, whereas longitudinal myocardial systolic velocity (V l ) and circumferential, longitudinal, and radial strains ( c , l , r ) were obtained by speckle tracking. Midwall shortening and peak basal longitudinal strain ( l ) were used as indices of regional function. Hypertensive subjects had lower velocities-tissue Doppler imaging EЈ and SЈ, and V l -and evidence of reduced regional function. Surprisingly, however, global 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 (both PϽ0.05). Conclusions-Hypertensive heart disease with normal ejection fraction is associated with reduced myocardial velocities and reduced regional function but normal global . 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 . (Circ Cardiovasc Imaging. 2009;2:382-390.)

Assessing Contractile Function When Ejection Fraction Is Normal

“…This impairment of the subendocardial longitudinal fibers also leads to attenuated subendocardial right-handed helix fiber shortening during systole, potentially resulting in a failure to fully counterbalance the subepicardial left-handed helix fiber shortening and resulting in increased circumferential deformation. 4,13,19 This putative mechanism for early alterations in LV deformation is consistent with the previously reported results that GLS is impaired despite preserved LVEF in various populations, including increasing age, 7 hypertension, 8 diabetes mellitus, 9 stable angina, 10 renal dysfunction, 11 obesity, 12 and HF with preserved LVEF. 13 Indeed, this increased circumferential deformation, which accompanies a reduced longitudinal deformation, merely because of the anatomic fiber direction within the cardiac wall, might be one of the major determinants of why LVEF remains within the normal range despite an ailing heart.…”

Masked hypertension in young patients after successful aortic coarctation repair: impact on left ventricular geometry and function

“…21 In hypertensive patients with apparently normal systolic function, and in presence of a normal diastolic function, the application of STI demonstrated the presence of preclinical LV systolic abnormalities. 22 Of note, in our study, global longitudinal deformation properties were not altered, whereas abnormal systolic function was detected only in the basal septal region. These findings are probably explained by the increased regional stress on the basal subendocardial longitudinal fibres, which are the most sensitive to ischaemia and the main contributors to long axis shortening, produced by MH.…”

“…22 The presence of this impairment in AoC patients with MH is a demonstration that MH is a dangerous condition, which can affect the cardiovascular system similarly to the classical hypertension.…”

American‐Style Football and Cardiovascular Health

“…More recently, speckle‐tracking echocardiography has enabled the ability to measure strain, a more sensitive measure of LV systolic function that has emerged as a highly reproducible technique with powerful prognostic implications in numerous clinical populations. Among older and comorbid patient populations, for example, reduced global longitudinal strain correlates significantly with both pathologic increases in SBP and the development of concentric LV hypertrophy 67, 68. The first application of strain echocardiography utilized among ASF athletes was reported recently.…”