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Original Articles

Cardiac Mechanics in Mild Hypertensive Heart Disease

A Speckle-Strain Imaging Study

Arumugam Narayanan, MD; Gerard P. Aurigemma, MD; Marcello Chinali, MD, PhD; Jeffrey C. Hill, RDCS; Theo E. Meyer, MD, PhD and Dennis A. Tighe, MD

From the Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass.

Correspondence to Gerard P. Aurigemma, MD, Division of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Room S3-860, Worcester, MA 01606. E-mail gerard.aurigemma{at}umassmed.edu

Received September 26, 2008; accepted July 21, 2009.

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 (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 (_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 E' and S', 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 P<0.05).

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 .

Key Words: mechanics • systole • hypertension • left ventricular mass • echocardiography

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