Published Online
on July 21, 2009

A more recent version of this article appeared on September 1, 2009

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Original Article

Cardiac Mechanics in Mild Hypertensive Heart Disease: A Speckle - Strain Imaging Study

Arumugam Narayanan; Gerard P. Aurigemma¹; Marcello Chinali; Jeffrey C. Hill; Theo E. Meyer and Dennis A. Tighe

University of Massachusetts Medical School, Worcester, MA

^* Corresponding author; email: gerard.aurigemma{at}umassmed.edu

Background—We hypothesized that abnormalities in regional systolic strain (), might be present among hypertensives with normal ejection fraction (EF), and, if present, could potentially 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 hypertensives with normal EF.

Methods and Results—Standard 2D Doppler echocardiography, tissue Doppler imaging (TDI), and 2D speckle strain imaging were performed in 52 hypertensives with normal EF and 52 controls of similar age. Peak systolic (S'), and diastolic (E') annular velocities were obtained by TDI, while longitudinal myocardial systolic velocity (V_l), and circumferential, longitudinal, and radial strains (_c, _l, _r) were all obtained by speckle tracking. Midwall shortening (FSmw) and peak basal longitudinal strain (_l) were used as indices of regional function. Hypertensives had lower velocities––TDI E' and S', as well as V_l––and evidence of reduced regional function. Surprisingly, however, global values did not differentiate hypertensives from controls. 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 EF is associated with reduced myocardial velocities, 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, as they occur prior to abnormalities in global .

Key Words: speckle tracking • systolic strain • systemic hypertension • left ventricular geometry • myocardial velocities