title: Prognostic value of longitudinal strain of subepicardial myocardium in patients with hypertension.
abstract: Global longitudinal strain is not well illustrated for the prognostic value in hypertension. This observational study investigated the prognostic value of global longitudinal strain, subendocardial longitudinal strain, and subepicardial (EpiLS) longitudinal strain in regularly treated hypertensive patients.
  
  
  
  Ninety-five hypertensive study participants (60.0% men, age 65.5 ± 12.0 years) were regularly treated for more than 1 year. We performed a two-dimensional echocardiographic study and obtained global peak systolic left ventricular longitudinal strain of subendocardial myocardium and the subepicardium (defined as subendocardial longitudinal strain and EpiLS, respectively). Cardiovascular events included cardiovascular death and any admission for stroke, acute coronary syndrome, or heart failure.
  
  
  
  After a follow-up period of 7.3 ± 2.0 years, 20 (21%) study participants had cardiovascular events. Significant differences between study participants with and without cardiovascular events were noted in diuretic administration (75.0 vs. 93.3%, P = 0.018), age (71.0 ± 11.6 vs. 64.0 ± 11.8 years, P = 0.02) and EpiLS (-16.0 ± 2.0 vs. -17.7 ± 3.0%, P = 0.04). Using multivariate Cox regression analysis, EpiLS was the only independent prognostic factor (hazard ratio 1.449, 95% confidence interval 1.027-2.045, P = 0.035). Using the cut off value of -17.57% for EpiLS (median value of EpiLS), the Kaplan-Meier survival curve revealed a significant difference (P = 0.016) associated with cardiovascular outcome.
  
  
  
  EpiLS was the only independent prognostic factor in regularly-treated hypertensive patients. Our results indicated that involvement of subepicardial myocardium may infer worse prognosis of hypertensive heart disease.
authors.affiliation: aDepartment of Internal Medicine, Division of Cardiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan *Wen-Huang Lee and Yen-Wen Liu contributed equally to the writing of this article.
authors.forename: Wen-Huang
authors.initials: WH
authors.lastname: Lee
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Liu
authors.forename: Li-Tan
authors.initials: LT
authors.lastname: Yang
authors.forename: Wei-Chuan
authors.initials: WC
authors.lastname: Tsai
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006333:Heart Failure / Q000209:etiology; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D010496:Pericardium / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D020521:Stroke / Q000209:etiology; D013599:Systole
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics