Correlates of global area strain in native hypertensive patients: a three-dimensional speckle-tracking echocardiography study

Aims The present study aimed to test the capability of real-time three-dimensional echocardiography (RT3DE) in characterizing early abnormalities of left ventricular (LV) structure and function in native, untreated hypertensive patients. Methods and results Thirty-eight newly diagnosed, never-treated hypertensives (H) and 38 healthy controls (C) underwent both standard echo-Doppler and RT3DE assessment. LV volumes and ejection fraction (EF), sphericity index, LV mass index (LVMi), global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated by RT3DE. The two groups were comparable for age and heart rate. Body mass index and blood pressure (BP) were significantly higher in H. LV volumes, EF, and sphericity index calculated by RT3DE did not differ significantly between the two groups, while LVMi was higher in H than in C (P < 0.0001). GAS (-29.1 +/- 2.5% in H vs. -33.6 +/- 3.4% in C), GLS, and GRS (all P < 0.0001) were lower in H, but GCS was not significantly different between the two groups. Among the different 3D strain components, GAS showed the best independent associations with mean BP (beta = -0.502, P < 0.0001) and LVMi (beta = -0.385. P < 0.001; cumulative R-2 = 0.55, P < 0.0001) in the pooled population. Conclusion RT3DE identifies early functional LV changes in native hypertensive patients. GAS is precociously reduced, and longitudinal and radial strain impaired, while circumferential strain is still preserved, supporting a normal LV chamber systolic function. Reduction of GAS is independently associated with both pressure overload and magnitude of the LV mass.