Left ventricular layer function in hypertension assessed by myocardial strain rate using novel one-beat real-time...

We recently developed novel software to measure phasic strain rate (SR) using automated one-beat real-time three-dimensional speckle tracking echocardiography (3D-STE) with high volume rates. We tested the hypothesis that left ventricular (LV) systolic function and relaxation analyzed by SR with the novel 3D-STE in hypertension (HTN) with hypertrophy may be impaired in the endocardium before there is LV systolic dysfunction. We measured LV longitudinal, radial and circumferential SR in patients with HTN (n=80, 69±7 years) and age-matched normotensive controls (n= 60, 69±10 years) using 3D-STE. HTN patients were divided into four groups according to LV geometry: normal, concentric remodeling, concentric hypertrophy and eccentric hypertrophy. We measured SR during systole as an index of systolic function, SR during isovolumic relaxation (IVR) as an index of relaxation and E/e' as an index of filling pressure. Endocardial SR during systole in HTN with concentric and eccentric hypertrophy decreased compared with that in controls despite no reduction in ejection fraction or epicardial SR. Endocardial radial SR during IVR decreased even in normal geometry, and it was further reduced in concentric remodeling and hypertrophy despite no reduction in epicardial SR. LV phasic SR assessed by 3D-STE with high volume rates is a useful index to detect early decreases in LV systolic function and to predict subclinical LV layer dysfunction in patients with HTN.