1033 Prominent longitudinal strain involvement of left ventricular basal segments in native hypertensive patients without clear-cut hypertrophy
Authors: Lembo M , Esposito R , Santoro C , Sorrentino R , Luciano F , Casciano O , Fiorillo L , La Mura L , Canonico M , Galderisi M 
Published: January 2020

Abstract

Background
Left ventricular (LV) global longitudinal strain (GLS) is able to detect an early subclinical dysfunction and it has been demonstrated to be a prognosticator in arterial hypertension. Information of regional longitudinal strain (LS) pattern has not been investigated in this clinical setting.

Purpose
We analyzed regional LV patterns of LS and base-to-apex behaviour of LS in newly diagnosed and never-treated hypertensive patients (HTN) without clear-cut LV hypertrophy (LVH).

Methods
166 HTN (M/F = 107/59; age 43.9 ± 14.3 years, blood pressure [BP] = 146.5± 10.7/90.1 ± 7.5 mmHg) and a control group of 94 healthy subjects (M/F = 58/36; age 41.2 ± 15.0 years) underwent standard echo-Doppler exam, including speckle tracking quantification of regional LS and GLS (considered in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio - RRSR = [ALS/(BLS + MLS)] - were also computed. Exclusion criteria were LVH (LV mass index ≥45 g/m^2.7 in females and ≥49 g/m^2.7 in males), diabetes mellitus, coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging.

Results
The two groups were comparable for sex, age, heart rate and LV ejection fraction (EF). Body mass index (BMI), systolic (SBP), diastolic (DBP) and mean BP (MBP) (all p &lt; 0.0001), LV mass index (p = 0.03), relative wall thickness (RWT) (p &lt; 0.02) and E/e’ ratio (p &lt; 0.01) were higher, and GLS lower (21.6 ± 2.0 vs. 22.2 ± 2.1%, p &lt; 0.02) in HTN. By analyzing regional LS, BLS (18.2 ± 2.1% vs. 19.2 ± 2.1%, p &lt; 0.0001) and MLS (20.7 ± 2.0 vs. 21.4 ± 2.1%, p = 0.007) resulted significantly lower in HTN, without significant difference in ALS (26.0 ± 3.6 vs. 25.9 ± 3.8%, p = 0.98). Accordingly, RRSR was higher in HTN (0.67 ± 0.09 vs. 0.64 ± 0.09, p &lt; 0.01). Even after excluding patients with LV concentric remodeling (RWT &gt; 0.42) (n = 34), BLS (p &lt; 0.0001) and MLS (p &lt; 0.002) were again lower and RRSR (p &lt; 0.01) higher in HTN than in controls. In the pooled population, BLS negatively correlated with SBP (r=-0.22), DBP (r=-0.25) and MBP (r=-0.26) (Figure) (all p &lt; 0.0001). By a multiple linear regression analysis, after adjusting for age, sex, BMI and RWT, the association between BLS and MBP remained significant (β coefficient=-0.23, p &lt; 0.0001), with an additional significant impact of male sex (β=-0.33, p &lt; 0.0001) (cumulative R²=0.18, SEE = 1.9%, p &lt; 0.0001).

Conclusions
Besides normal LV EF, GLS is lower in HTN. LS dysfunction involves basal and, with a lower extent, middle myocardial segments, with a compensation of apical segments. RRSR appears to be significantly higher in HTN. These results are even confirmed in hypertensive patients with normal LV geometry. The association of BLS and BP appears to be independent on several confounders. Regional LS pattern might be useful to detect very early LV systolic abnormalities in arterial hypertension.
Abstract 1033 Figure. Relation between MBP and BLS