Myocardial strain indices and coronary flow reserve are only mildly affected in healthy hypertensive patients

Abstract

Abstract Hypertension is a major risk factor for cardiovascular disease and is associated with functional and structural changes in the heart and the vessels. Left ventricular deformation imaging with 2D Strain Echocardiography (2DSTE) and stress echocardiography with a vasodilator,such as dipyridamole (DIPSE), are useful tools for the detection of early myocardial abnormalities in hypertensive patients The aim of the current study was to investigate whether early (relatively healthy) hypertensive patients with normal left ventricular (LV) ejection fraction may differ in 2D Strain indices at baseline and in response to a stress test such as dipyridamole, compared to healthy controls. In the current study, the associations of 2DSTE indices and their changes following DIPSE with other studied parameters were also assessed. Forty-seven male hypertensive patients (aged 57±9 years) with normal ejection fraction and without left ventricular hypertrophy and 20 healthy male subjects were studied with conventional and 2D Strain echocardiography at rest and post DIPSE. Coronary flow reserve (CFR) in the left anterior descending artery following DIPSE was also evaluated. Global longitudinal strain (GLS) and TWIST were higher while UNTWIST rate was lower in hypertensives versus controls (p<0.05 for all). TWIST remained higher in hypertensives (p=0.021) after adjustment for differences in age and body mass index (BMI) between the groups. CFR was higher in controls compared to hypertensives even after adjustment for confounders (4.14 vs. 2.53, p=0.001). DIPSE-induced changes did not differ between the groups after adjustment for age and BMI (p>0.05 for all). DIPSE-induced improvement in GLS was associated with higher CFR only in hypertensive patients (r −0.372, p=0.010). The current study showed that well controlled hypertensive patients have mild echocardiographic differences compared to controls. Some of these differences appear to depend on age and Body mass index. A “hyper-rotation” phenomenon (higher TWIST) early in hypertension may be a compensatory mechanism to preserve global systolic LV function. Coronary microcirculatory function was impaired in hypertensive patients, albeit within normal range, and was associated with DIPSE-induced changes in myocardial long-axis systolic function. Funding Acknowledgement Type of funding sources: None.