Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction

Background Early detection of risk factors for left ventricular (LV) dysfunction may be useful in patients with high blood pressure (HBP). Methods Patient from an outpatient HBP clinic underwent a two-dimensional Doppler-coupled echocardiography with determination of LV global longitudinal strain (GLS) by speckle-tracking. Results Among 200 patients (mean age 61.79.7 years), 155 were overweight, 93 had diabetes, 83 had dyslipidemia, and 109 had uncontrolled HBP. LV hypertrophy (LVH) was found in 136 patients (68%), including concentric (n=106) and eccentric (n=30) LVH. Diastolic dysfunction patterns were observed in 178 patients (89%), and increased filling pressures were observed in 37 patients (18.5%). GLS ranged from -25% to -11.6% (mean -16.9 +/- 3.2%). Low GLS values (>-17%) were found in 91 patients (45.5%), 68 with and 23 without LVH. In univariate analysis, a reduced GLS was associated with HBP lasting for >10 years (odds ratio (OR)=3.51, 95% confidence interval (CI) 1.73-7.09; p=0.002), uncontrolled HBP (OR=3.55, 95% CI 1.96-6.43; p<0.0001), overweight (OR=2.01, 95% CI 0.93-4.31; p=0.0028), diabetes (OR=2.21, 95% CI 1.25-3.90; p=0.006), dyslipidemia (OR=2.16, 95% CI 1.22-3.84; p=0.008), renal failure (OR=4.27, 95% CI 1.80-10.10; p=0.001), an increased Cornell index (OR=3.70, 95% CI 1.98-6.90; p<0.0001), concentric LVH (OR=9.26, 95% CI 2.62-32.73; p=0.001), remodeling (OR=8.51, 95% CI 2.18-33.23; p=0.002), and filling pressures (OR=7.1, 95% CI 2.9-17.3; p<0.0001). In multivariable analysis, duration of HBP (p=0.038), uncontrolled BP (p=0.006), diabetes (p=0.023), LVH (p=0.001), and increased filling pressures (p=0.003) remained associated with GLS decline. Conclusion Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH.