Impaired Endocardial Radial Strain in Hypertensive Patients with Electrocardiographic Strain Pattern on Twodimensional Speckle-Tracking Echocardiography

Abstract

Background: Strain ST-T changes on Electrocardiography (ECG) is a well-recognized marker of the presence and severity of Left Ventricular (LV) hypertrophy, which is usually associated with subendocardial dysfunction. However, the relationship between ST-T change and subendocardial dysfunction in hypertensive patients is unknown. Recently, two-dimensional speckle-tracking echocardiography has been used to define myocardial deformation parameters of the LV segment. Herein, we assessed subendocardial dysfunction patients with strain ST-T changes on electrocardiogram using two-dimensional speckle-tracking echocardiography. Methods: Parasternal short-axis and apical long-axis views of the LV were acquired in 42 controls and 69 essential hypertensive patients. Patients were divided into two groups according to presence (n = 29) or absence (n = 40) of strain ST-T changes. Radial, circumferential and longitudinal strain in subendocardial and subepicardial layers were calculated. Results: No significant intergroup differences in circumferential strain in the subendocardial and subepicardial layers were observed. Longitudinal strain was decreased in hypertensive patients with strain ST-T changes versus patients without strain ST-T changes or control subjects (antero-septal: p < 0.0001; posterior: p < 0.005). Although epicardial radial strain was similar between patients with and without strain ST-T changes, endocardial radial strain was reduced in strain ST-T change group versus the no ST-T change group (antero-septal : 19.3 ± 14.5 vs. 31.9 ± 15.8, p < 0.01; posterior : 25.4 ± 14.9 vs. 34.5 ± 11.4, p < 0.05). Conclusions: Hypertensive patients with strain ST-T changes exhibit impaired longitudinal strain and endocardial radial strain, with preserved circumferential strain and epicardial radial strain. The impairment of endocardial radial strain in hypertensive patients with strain ST-T changes suggests a possible link between strain ST-T changes and subendocardial dysfunction.