Left ventricular deformation in relation to the geometric pattern in hypertensive patients

This study aimed to evaluate left ventricular deformation in relation to the geometric pattern in hypertensive patients with normal left ventricular ejection fraction using speckle tracking echocardiography (STE). Transthoracic echocardiography was performed in 80 hypertensive patients and 50 age- and gender-matched normotensive subjects. Left ventricular geometric pattern was defined according to left ventricular mass index and relative wall thickness as normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. Quantitative measurements of longitudinal, circumferential, and radial strain were performed for endocardial, middle, and epicardial layers of the left ventricular wall at each segment. The longitudinal strain in hypertension was lower for all 3 layers in concentric (n = 20) and eccentric hypertrophy (n = 20) than normotensive subjects (n = 50, P < .01). It was also significantly lower for the endocardial layer in concentric remodeling (n = 20, P = .04 vs normotensive subjects). The circumferential strain in hypertension was higher in normal geometry or concentric remodeling, lower in concentric hypertrophy, and at similar level in eccentric hypertrophy, in comparison with normotensive subjects. The difference from normotensive subjects was statistically significant for the endocardial and middle layers in normal geometry (P < .03), for the endocardial layer in concentric remodeling (P < .02), and for the middle and epicardial layers in concentric hypertrophy (P≤.001). The radial strain and twist did not differ between normotensive and hypertensive subjects (P > .08). Left ventricular deformation in hypertension occurs with various geometric patterns disproportionately in the endocardial, middle and epicardial layers and differently in the longitudinal and circumferential orientations.