Role of strain echocardiography in patients with hypertension

Abstract

Hypertension is a well-recognized risk factor for the development of cardiovascular disease, and the early detection of cardiac changes from hypertension can allow reversing these. Hypertensive heart diseases (HHD) refer to the complex and diverse change of the cardiac structure and function secondary to hypertension. Although conventional echocardiography is the most common imaging modality in detecting HHD, it cannot detect subtle changes of cardiac structure in subclinical states. Because strain echocardiography is another echocardiographic modality can detect subclinical myocardial dysfunction by measuring intrinsic myocardial deformation, it became more and more popular in clinical and research fields. In this review article, we described the basic concept of strain echocardiography and summarized several clinical studies showing its clinical utilities in the detection of HHD.

Keywords: Echocardiography; Hypertension; Hypertrophy; Left ventricular; Strain echocardiography.

Fig. 1

Overview of the structural and functional alterations present in hypertensive heart disease. LA, left atrium; LV, left ventricular; RA, right atrium; RV, right ventricular

Fig. 2

Myocardial strain and strain rate. Simple diagram showing the principle of strain and strain rate. Strain is expressed as a fractional length change, where shortening is a negative value and lengthening a positive value. Strain is calculated as the difference (ΔL) of the initial (L₀) and the final distance (L) between two points divided by the initial distance. Strain rate is the deformation per unit time (Δt), and derives from the ratio between the velocity variation and the initial distance between two points

Fig. 3

Demonstration of a longitudinal strain and strain rate analysis in the left ventricle using 2-dimensional speckle-tracking echocardiography. Example of a strain curve (A) and a strain rate curve (B) for one heart cycle

Fig. 4

Demonstration of a 2-dimensional strain analysis with GE EchoPAC PC software. After tracing of the endocardial border, the software provides global and regional myocardial strain values automatically in apical 4 chamber (A), apical 2 chamber (B), and apical 3 chamber views (C). The GE EchoPAC algorithm can provide bull’s eye maps of regional longitudinal strain values (D)

Fig. 5

Demonstration of LA and RV strain analysis using 2-dimensional speckle-tracking echocardiography (A). LA strain and illustration of the 3 phases of LA function with an R-R gating analysis. RV longitudinal strain calculated as the average of the six-segment model (B). ECG, electrocardiography; LA, left atrium; PACS, peak atrial contraction strain; PALS, peak atrial longitudinal strain; RV, right ventricular

Fig. 6

Schematic illustration showing clinical indications of the speckle-tracking echocardiography. Speckle-tracking strain is an increasingly used echocardiographic technology that can provide additional clinical utility. LA, left atrium; LV, left ventricular; RV, right ventricular