Evaluation of Left Ventricular Systolic Functions of Patients with Exaggerated High Blood Pressure Response to Treadmill Exercise Test with Two-Dimensional Longitudinal Strain Imaging

BACKGROUND: An exaggerated hypertensive response (EHR) during exercise is linked to increased cardiovascular risk and mortality. This study aims to assess structural and functional cardiac changes, along with subclinical myocardial damage, using transthoracic echocardiography (ECHO) and 2D longitudinal strain analysis in patients showing a hypertensive response to treadmill exercise. METHODS: Patients without known chronic diseases, presenting to the Cardiology Department at Health Sciences University Gülhane Training and Research Hospital, were divided into 2 groups based on their blood pressure response during treadmill exercise: exaggerated hypertensive response (EHR, n = 42) and normal response (control, n = 44). Left ventricular longitudinal strain was assessed using transthoracic echocardiography, and global longitudinal strain (GLS) was calculated as the average from all segments. Data analysis was performed using SPSS 26. RESULTS: No significant differences were found between the groups regarding baseline demographic and laboratory parameters (P > .05 for all). However, the EHR group exhibited significantly higher interventricular septum thickness, mitral A velocity, and mitral annulus velocity (a'), while mitral annulus velocity (e') was significantly lower (P < .05 for all). Additionally, left ventricular (LV) mass index, left atrial volume index, mitral E/e' ratio, deceleration time, and relative wall thickness (RWT) were higher in the EHR group, while the mitral E/A ratio was lower (P < .05 for all). The GLS was also significantly lower in the EHR group (P < .05). CONCLUSION: Left ventricular geometry parameters, such as LV mass index and RWT, and GLS findings indicating subclinical cardiac damage, were significantly altered in the EHR group, suggesting a higher risk of LV hypertrophy and myocardial dysfunction.