title: Left ventricular function in hypertension: new insight by speckle tracking echocardiography.
abstract: BACKGROUND
  Conventional transthoracic echocardiography (TTE) and tissue Doppler imaging (TDI) are usually unable to reveal very early subtle abnormalities in left ventricular (LV) systolic function caused by hypertension, prior to manifestation of hypertrophy (LVH). This study was undertaken to assess whether speckle tracking echocardiography (STE) provides more insight into early hypertension-induced LV systolic dysfunction, with the purpose of identifying patients at higher risk for heart failure (HF).
  
  
  METHODS
  Fifty-one patients (56.5 ± 14 years) and 51 controls (52 ± 12.6 years) were enrolled. According to the presence or absence of LVH, patients were classified as LVH((+)) and LVH((-)) , respectively. Global longitudinal function was calculated by TDI, global strains [longitudinal (LS), radial (RS), and circumferential (CS)] and twist were assessed by STE.
  
  
  RESULTS
  Conventional TTE showed a LV diastolic dysfunction with normal systolic function in all patients. TDI was able to detect a systolic dysfunction only in the LVH((+)) group (P < 0.001) whereas STE revealed an impairment of systolic LS in all patients, including those without hypertrophy (P = 0.02). Furthermore, in the LVH((+)) group, STE showed reduced RS and increased CS and twist. These last alterations were observed with respect to both controls (RS: P = 0.02; CS: P = 0.05; twist: P < 0.001) and LVH((-)) patients (RS: P = 0.01; CS: P = 0.003; twist: P = 0.001).
  
  
  CONCLUSIONS
  In hypertensive patients, STE provides more detailed information than conventional echocardiography and TDI, since it reveals a systolic dysfunction before hypertrophy occurs (Stage A of ACC/AHA classification of HF) and identifies some early LV mechanic changes that might improve the clinical management of these patients.
authors.affiliation: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Imbalzano
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Oreto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mandraffino
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà-Piccione
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.forename: Carlo
authors.initials: C
authors.lastname: Saitta
authors.forename: Antonino
authors.initials: A
authors.lastname: Saitta
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*