Detection of irregular patterns of myocardial contraction in patients with hypertensive heart disease

OBJECTIVE: To evaluate the effect of myocardial hypertrophy in patients with arterial hypertension on regional myocardial function and left ventricular twist. METHODS: Eighty patients with normal coronary angiograms and ejection fraction higher than 55% were divided according to left ventricular mass indexed to body height (LVMH) into a group with and without left ventricular hypertrophy (LVH). The absolute values and time-to-peak values of overall strain (S), systolic (SRS) and early diastolic strain rate (SRE) were measured in longitudinal, circumferential and radial directions using two-dimensional speckle tracking echocardiography. Left ventricular twist and twist rate curves were calculated from rotation curves obtained from apical and basal parasternal short-axis planes. RESULTS: In the patient group with LVH, SRS and SRE, quantified in longitudinal and circumferential direction, were lower compared with the group without LVH. In addition, systolic twist rate and diastolic untwist rate were significantly lower in this patient group, too. No differences between patients groups were found for peak overall S measured in any direction or left ventricular twist. LVMH correlated significantly with longitudinal SRS (r = 0.48, P < 0.001), longitudinal SRE (r = -0.48, P < 0.001), systolic twist rate (r = 0.37, P = 0.006) and diastolic untwist rate (r = -0.27, P = 0.046). CONCLUSION: In conclusion, LVH in patients with arterial hypertension predominantly affected longitudinal and circumferential deformation rate. Moreover, LVH resulted in a significant reduction of systolic twist rate and diastolic untwist rate, whereas overall left ventricular twist angle was not influenced by LVMH.