title: Two-dimensional speckle-tracking echocardiography-based left atrial strain parameters predict masked hypertension in patients with hypertensive response to exercise.
abstract: OBJECTIVE
  We aim to study left atrial (LA) strains in patients with hypertensive response to exercise (HRE) and determine their usefulness in predicting masked hypertension (HT).
  
  
  METHODS
  Ninety-eight normotensive patients who had HRE were included and were divided into two groups after masked HT had been diagnosed by ambulatory blood pressure monitoring. Conventional echocardiographic parameters and two-dimensional speckle-tracking echocardiography-based LA strain parameters were compared.
  
  
  RESULTS
  Patients with masked HT have higher left ventricle mass index (LVMI) (88.1±11.3 vs. 82.5±8.7 g/m, P<0.05), left atrium maximum volume index (LAVI) (34.5±5.1 vs. 30.2±5.6 ml/m, P<0.001), lower global longitudinal LA strain during ventricular systole (GLAs-res) (32.5±8.9 vs. 40.2±9.1%, P<0.001), and lower global longitudinal LA strain during late diastole (GLAs-pump) (15.8±4.1 vs. 18.1±5.8%, P<0.05). In univariate analysis, a good negative correlation was found between GLAs-res versus LAVI (r=-0.451, P<0.001), GLAs-res versus LVMI (r=-0.457, P<0.001) and a moderate negative correlation was present between GLAs-pump versus LAVI (r=-0.317, P<0.001) and GLAs-pump versus LVMI (r=-0.288, P<0.05). GLAs-res and LAVI were found to be independent predictors of masked HT. Receiver-operating characteristic analysis was carried out. Area under the curve to predict masked HT was 0.729 (95% confidence interval: 0.623-0.832, P<0.001). GLAs-res less than 33.1% predicted masked HT with 73% sensitivity and 61.5% specificity.
  
  
  CONCLUSIONS
  LA strain parameters were impaired in patients with masked HT and can be used to predict the presence of masked HT in patients with HRE.
authors.affiliation: aDepartment of Cardiology, Fatih University bDepartment of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital cDepartment of Cardiology, Dr Siyami Ersek Chest and Cardiovascular Surgery Hospital, Istanbul, Turkey.
authors.forename: Soe M
authors.initials: SM
authors.lastname: Aung
authors.forename: Ahmet
authors.initials: A
authors.lastname: Güler
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Güler
authors.forename: Can Y
authors.initials: CY
authors.lastname: Karabay
authors.forename: Ilyas
authors.initials: I
authors.lastname: Akdemir
mesh_terms: D000328:Adult; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D025401:Echocardiography, Stress; D015444:Exercise; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D059468:Masked Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged