5 Key points
- Reduced longitudinal strain in the basal septal (inferoseptal and/or anteroseptal) wall with normal strain values in the other segments. This is typically accompanied with a moderate amount of post systolic strain in the basal septal segments, PSS may affect diastolic relaxation.
- A peak systolic longitudinal strain value of -10.5% discriminates LVH due to hypertension from hypertrophic cardiomyopathy.
- GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality (baseline GLS >-16% )
- ECV on CMR is associated with the amount of GLS reduction. GLS also significantly correlates with ECG voltage criteria
- Enhanced LV twist angle and circumferential strain appears to be a compensatory mechanism (compensating for the loss in longitudinal shortening) in hypertensive patients during the earlier stages of concentric remodeling and concentric hypertrophy. This results in a preservation of LVEF
Case:
References:
- Mordi IR, Singh S, Rudd A, Srinivasan J, Frenneaux M, Tzemos N, Dawson DK. Comprehensive Echocardiographic and Cardiac Magnetic Resonance Evaluation Differentiates Among Heart Failure With Preserved Ejection Fraction Patients, Hypertensive Patients, and Healthy Control Subjects. JACC Cardiovasc Imaging. 2017 Aug 11. pii: S1936-878X(17)30617-4.
- Soufi Taleb Bendiab N, Meziane-Tani A, Ouabdesselam S, Methia N, Latreche S, Henaoui L, Monsuez JJ, Benkhedda S. Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction. Eur J Prev Cardiol. 2017 Sep;24(14):1463-1472.
- Göksülük H, Habibova U, Ongun A, Akbulut M, Özyüncü N, Kürklü TST, Erol C. Evaluation of the effect of dipping pattern in hypertensive patients on the left ventricular systolic functions by two-dimensional strain analysis. Echocardiography. 2017 May;34(5):668-675.
- Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, Sengeløv M, Jørgensen PG, Mogelvang R, Shah AM, Jensen JS. Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population: The Copenhagen City Heart Study. Circ Cardiovasc Imaging. 2017 Mar;10(3). pii: e005521.
- Saito M, Khan F, Stoklosa T, Iannaccone A, Negishi K, Marwick TH. Prognostic Implications of LV Strain Risk Score in Asymptomatic Patients With Hypertensive Heart Disease. JACC Cardiovasc Imaging. 2016 Aug;9(8):911-21.
- Cikes M, Solomon SD. Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. Eur Heart J. 2016 Jun 1;37(21):1642-50. doi: 10.1093/eurheartj/ehv510. Epub 2015 Sep 28. Review.
- Nogi S, Ito T, Kizawa S, Shimamoto S, Sohmiya K, Hoshiga M, Ishizaka N. Association between Left Ventricular Postsystolic Shortening and Diastolic Relaxation in Asymptomatic Patients with Systemic Hypertension. Echocardiography. 2016 Feb;33(2):216-22. doi: 10.1111/echo.13022.
- Kishi S, Teixido-Tura G, Ning H, Venkatesh BA, Wu C, Almeida A, Choi EY, Gjesdal O, Jacobs DR Jr, Schreiner PJ, Gidding SS, Liu K, Lima JA. Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age: The CARDIA Study. J Am Coll Cardiol. 2015 Jun 30;65(25):2679-87.
- Phelan D, Thavendiranathan P, Popovic Z, Collier P, Griffin B, Thomas JD, Marwick TH. Application of a parametric display of two-dimensional speckle-tracking longitudinal strain to improve the etiologic diagnosis of mild to moderate left ventricular hypertrophy. J Am Soc Echocardiogr. 2014 Aug;27(8):888-95.
- Celic V, Tadic M, Suzic-Lazic J, Andric A, Majstorovic A, Ivanovic B, Stevanovic P, Iracek O, Scepanovic R. Two- and three-dimensional speckle tracking analysis of the relation between myocardial deformation and functional capacity in patients with systemic hypertension. Am J Cardiol. 2014 Mar 1;113(5):832-9.
- Badran HM, Faheem N, Ibrahim WA, Elnoamany MF, Elsedi M, Yacoub M. Systolic function reserve using two-dimensional strain imaging in hypertrophic cardiomyopathy: comparison with essential hypertension. J Am Soc Echocardiogr. 2013 Dec;26(12):1397-406.
- Beladan CC, Popescu BA, Calin A, Rosca M, Matei F, Gurzun MM, Popara AV, Curea F, Ginghina C. Correlation between global longitudinal strain and QRS voltage on electrocardiogram in patients with left ventricular hypertrophy. Echocardiography. 2014 Mar;31(3):325-34.
- Hwang JW, Kang SJ, Lim HS, Choi BJ, Choi SY, Hwang GS, Yoon MH, Shin JH, Tahk SJ. Impact of arterial stiffness on regional myocardial function assessed by speckle tracking echocardiography in patients with hypertension. J Cardiovasc Ultrasound. 2012 Jun;20(2):90-6.
- Cameli M, Lisi M, Righini FM, Massoni A, Mondillo S. Left ventricular remodeling and torsion dynamics in hypertensive patients. Int J Cardiovasc Imaging. 2013 Jan;29(1):79-86.
- Goebel B, Gjesdal O, Kottke D, Otto S, Jung C, Lauten A, Figulla HR, Edvardsen T, Poerner TC. Detection of irregular patterns of myocardial contraction in patients with hypertensive heart disease: a two-dimensional ultrasound speckle tracking study. J Hypertens. 2011 Nov;29(11):2255-64.
- Cikes M, Sutherland GR, Anderson LJ, Bijnens BH. The role of echocardiographic deformation imaging in hypertrophic myopathies. Nat Rev Cardiol. 2010 Jul;7(7):384-96.
- Baltabaeva A, Marciniak M, Bijnens B, Moggridge J, He FJ, Antonios TF, MacGregor GA, Sutherland GR. Regional left ventricular deformation and geometry analysis provides insights in myocardial remodelling in mild to moderate hypertension. Eur J Echocardiogr. 2008 Jul;9(4):501-8.
- Mottram PM, Haluska B, Yuda S, Leano R, Marwick TH. Patients with a hypertensive response to exercise have impaired systolic function without diastolic dysfunction or left ventricular hypertrophy. J Am Coll Cardiol. 2004 Mar 3;43(5):848-53.