Key result
Hypertensive patients with an ECG strain pattern had significantly lower layer-specific myocardial strain compared to those without strain, particularly in the endocardium (P<0.001).
Why the study?
The relationship between ECG strain, increased LV mass, and ischemic heart disease has not been thoroughly studied, leaving unclear whether strain reflects myocardial ischemic changes or merely an electrical phenomenon.
Does the presence of an ECG strain pattern correlate with reduced layer-specific myocardial strain in hypertensive patients with normal coronaries?
Observational (n=115)
Does the presence of an ECG strain pattern correlate with reduced layer-specific myocardial strain in hypertensive patients with normal coronaries?
p-value: p=<0.001
ECG strain patterns in hypertensive patients correlate with significantly reduced layer-specific myocardial strain, particularly in the endocardium, suggesting subendocardial ischemia despite normal epicardial coronary arteries.
ECG strain may flag higher ischemic risk in hypertensives; hypothesis-generating and should not yet change practice.
Background: ST depression and T-wave inversion (TWI) are classic ECG strain patterns that indicate left ventricular hypertrophy (LVH) and a poor prognosis. The relationship between strain and increased left ventricular (LV) mass and its relationship to ischemic heart disease (IHD), however, hasn't been thoroughly studied. Objectives: The aim of the current work was to assess if hypertensive cases with a strain pattern on ECG have more ischemic changes at the level of the myocardium or if it is just an electrical phenomenon associated with hypertension (HTN). Patients and methods: The current study comprised 100 hypertensive cases who were undergone coronary angiography for suspected angina pectoris and revealed normal coronaries, and 15 age and sex-matched normotensive health volunteers (control group). Patients were further divided into 2 groups; Group I: included 50 hypertensive patients with strain criteria by ECG, and Group II: included 50 hypertensive patients without strain criteria. A conventional echocardiogram was performed using M-mode, 2D, Doppler, and Tissue Doppler, and then myocardial strain measured by 2D speckle tracking echocardiography (STE) was used to evaluate the layers of the myocardium. Results: The layer-specific strain (LSS) was significantly lower in both hypertensive groups compared to the controls in all three layers (endocardium, myocardium, and epicardium). The LSS was significantly decreased in GI cases with strain ST-T changes than in GII cases with no strain ST-T changes. The endocardial layer was much more affected than the mid-myocardial and epicardial layers; in GI, the endocardial layer's P-value was <0.001, while in the mid-myocardial layer the P-value was <0.05), and in the epicardial layer P-value was <0.05. Conclusion: It could be concluded that hypertensive patients with LVH and strain pattern have more ischemic changes than hypertensive patients without strain and the ischemic changes are more profound at the level of the endocardium.
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Elokda et al. (2023) conducted an observational in Hypertension (n=115). ECG strain pattern (ST depression and T-wave inversion) vs. Hypertensive patients without ECG strain pattern was evaluated on Layer-specific strain (LSS) across endocardium, myocardium, and epicardium (p=<0.001). Hypertensive patients with an ECG strain pattern had significantly lower layer-specific myocardial strain compared to those without strain, particularly in the endocardium (P<0.001).
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