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Updated: Aug 15, 2025
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Unmasking left ventricular systolic dysfunction in masked hypertension: looking at myocardial strain. A review and
Cesare Cuspidi1, Elisa Gherbesi2,3, Andrea Faggiano2,3
1Department of Medicine and Surgery, University of Milano-Bicocca.
Insights
Masked hypertension (MH) is linked to worse left ventricular (LV) systolic function, specifically in global longitudinal strain (GLS), even when ejection fraction appears normal. Speckle tracking echocardiography (STE) can detect these early changes.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Masked hypertension (MH) is a blood pressure phenotype characterized by normal office readings and elevated out-of-office readings.
- MH is associated with increased risks of organ damage, cardiovascular disease, and mortality compared to true normotension.
- The impact of MH on left ventricular (LV) systolic function, particularly early, subclinical impairment, remains incompletely understood.
Purpose of the Study:
- To investigate LV systolic function in untreated individuals with MH.
- To focus on LV global longitudinal strain (GLS) as a sensitive marker of systolic function using speckle tracking echocardiography (STE).
- To compare GLS in MH patients versus normotensive controls.
Main Methods:
- A systematic review and meta-analysis of studies comparing LV GLS in MH patients and normotensive controls.
- Data were sourced from PubMed, OVID, EMBASE, and Cochrane Library databases up to June 30, 2022.
- Included studies assessed MH using ambulatory blood pressure monitoring (ABPM).
Main Results:
- Six studies included 329 untreated MH patients and 376 normotensive controls.
- No significant difference in LV ejection fraction (LVEF) was observed between groups.
- LV global longitudinal strain (GLS) was significantly worse in the MH group compared to normotensive controls.
Conclusions:
- Speckle tracking echocardiography (STE) can reveal early, subclinical LV systolic dysfunction in masked hypertension that is not apparent with conventional echocardiography.
- STE may enhance the detection of adverse prognostic subclinical organ damage in MH.
- Implementing STE in clinical practice could improve risk stratification for patients with MH.
Background And Aim:
A growing body of evidence supports the view that masked hypertension (MH) (i.e. normal office and elevated out-of-office BP) is a blood pressure (BP) phenotype associated with increased risk of subclinical organ damage, cardiovascular disease and death as compared to true normotension. Whether left ventricular (LV) systolic function is impaired in individuals with MH is still a poorly defined topic. Therefore, we aimed to provide a new piece of information on LV systolic dysfunction in the untreated MH setting, focusing on speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of systolic function than conventional LV ejection fraction (LVEF).
Methods:
A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception until June 30, 2022. Full articles reporting data on LV GLS in MH, as assessed by ambulatory BP monitoring (ABPM), and normotensive controls were considered suitable for the purposes of review and meta-analysis.
Results:
A total of 329 untreated individuals with MH and 376 normotensive controls were included in six studies. While pooled average LVEF was not different between groups [64.5 ± 1.5 and 64.5 ± 1.3%, respectively, standard means difference (SMD): -0.002 ± 0.08, confidence interval (CI): 0.15/-0.15, P = 0.98), LV GLS was worse in MH patients than in normotensive counterparts (-18.5 ± 0.70 vs. -20.0 ± 0.34%, SMD: 0.68 ± 0.28, CI: 0.12/1.24, P < 0.01).
Conclusions:
Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the MH setting can be unmasked by STE and that its implementation of STE in current practice may improve the detection of subclinical organ damage of adverse prognostic significance.
