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

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Essential hypertension with normal left ventricular ejection fraction (n=111). Intervention: Strain ST-T changes on ECG vs. Absence of strain ST-T changes. Primary outcome: Endocardial radial strain (antero-septal segment) (p=<0.01).

Yoshikazu Ohara

doi:10.15226/2374-6882/1/2/00110

January 1, 2014Journal of Clinical Trials in CardiologyOpen Access

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

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Key result

Hypertensive patients with strain ST-T changes on ECG exhibited significantly impaired endocardial radial strain compared to those without ST-T changes (antero-septal: 19.3% vs 31.9%, p<0.01).

Why the study?

Does the presence of electrocardiographic strain ST-T changes correlate with impaired subendocardial strain in hypertensive patients?

Study Design

Type

Cross-Sectional (n=111)

Multicenter

No

Structured PICO

Does the presence of electrocardiographic strain ST-T changes correlate with impaired subendocardial strain in hypertensive patients?

P

Population

111 subjects, comprising 69 hypertensive patients with normal left ventricular ejection fraction and 42 matched controls, evaluated cross-sectionally for subendocardial dysfunction.

E

Exposure

Presence of electrocardiographic strain ST-T changes (defined as down sloping convex ST-segment depression combined with an inverted asymmetrical T-wave with polarity opposite to the main QRS deflection in leads V5 and/or V6).

C

Comparator

Hypertensive patients without electrocardiographic strain ST-T changes, and control subjects without overt cardiac disease.

O

Outcome

Radial, circumferential, and longitudinal strain in the subendocardial and subepicardial layers at the posterior and anteroseptal segments measured by two-dimensional speckle-tracking echocardiography.surrogate

Main Result

Absolute Event Rate: 19.3% vs 31.9%

p-value: p=<0.01

Hypertensive patients with ECG strain ST-T changes exhibit impaired endocardial radial and longitudinal strain despite preserved LVEF, suggesting a link between ECG strain patterns and subclinical subendocardial dysfunction.

Limitations

Myocardial strain was assessed only at the mid antero-septal and posterior walls, so results may not apply to other left ventricular segments.
The study population was heterogeneous, and the presence of silent myocardial ischemia cannot be completely ruled out due to lack of stress testing or coronary angiography.
Layer-specific analysis of myocardial deformation parameters has not been specifically validated in an experimental model.
Assessed myocardial strain only at the mid antero-septal and posterior walls, so results may not apply to other LV segments.
Heterogeneous study population with possible inclusion of a small number of subjects with silent myocardial ischemia due to lack of confirmation by stress testing or coronary angiography.

Implication

May indicate subclinical dysfunction in hypertensives with preserved LVEF; hypothesis-generating and should not yet change practice.

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.

Discussion

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Cite This Study

Yoshikazu Ohara (2014) conducted a cross-sectional in Essential hypertension with normal left ventricular ejection fraction (n=111). Strain ST-T changes on ECG vs. Absence of strain ST-T changes was evaluated on Endocardial radial strain (antero-septal segment) (p=<0.01). Hypertensive patients with strain ST-T changes on ECG exhibited significantly impaired endocardial radial strain compared to those without ST-T changes (antero-septal: 19.3% vs 31.9%, p<0.01).

synapsesocial.com/papers/6a20679070716c92859cd794 https://doi.org/10.15226/2374-6882/1/2/00110

Topics

Echocardiography

Hypertension management

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

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

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

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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