Left ventricular strain and arterial hypertension: Is longitudinal strain ready for primetime?

Abstract

More than one decade passed from the first studies regarding left ventricular (LV) mechanics in patients with arterial hypertension (AH). At the beginning, the assessment of LV strain was considered as a research tool, which was exclusively used in well-equipped echocardiographic laboratories. What is the situation nowadays and does LV strain still has status of "fancy gadget" or necessity in the evaluation of subclinical subtle cardiac damage in patients with AH?The first studies used tissue-Doppler derived LV strain and soon after speckle tracking imaging arrived and completely replaced tissue-Doppler strain technique. Pioneer investigations showed difference between physiological LV hypertrophy in athletes and pathological LV hypertrophy in AH patients using LV longitudinal strain. 1,2 However, studies that revealed LV strain deterioration in the young untreated hypertensive patients without LV hypertrophy broke the prejudice that LV hypertrophy is "conditio sine qua non" for LV strain reduction. 3The most of studies emphasized the effect of AH on LV longitudinal strain and impairment of LV circumferential and radial strains, if detected, was put aside. There are several reasons for this attitude of investigators. Namely, strain evaluation is unfortunately still vendor-dependent and this remains the most important limitation of this imaging technique for more than decade. A lot of effort was put in the attempt to establish similar kind of LV longitudinal strain calculation with different vendors, and nowadays, this difference is minimized, but still exists. 4 We are still far a way of establishing the same consensus in calculation of LV circumferential and radial strain. The other important reason that may explain focusing on LV longitudinal strain was the fact that most of vendors provided quick assessment only of LV longitudinal strain, whereas the evaluation of circumferential and radial strains required special software and therefore remained more scientific than clinical tool. The major problem was also setting proper cutoff values for all types of LV strain. This problem was almost overcome for LV longitudinal strain in the last couple of years, and current guidelines claimed that LV longitudinal strain should be >−20% in healthy persons. 5 However, the recommendation still considers −16% as the cutoff of normality. 5This only confirms uncertainty that still exists in this area and large gray zone of LV longitudinal strain (between −16% and −20%). We are not even close to make this kind of consensus for LV circumferential and radial strain. However, one thing is certain, when LV longitudinal strain assessment is made using the same vendor or software from the time of diagnosis through the whole follow-up, one could be certain that evaluation of strain is much more reproducible than calculation of LV ejection fraction over this period. 6 According to the physiological mechanics of LV systolic function, longitudinal dysfunction may serve as a marker at an early stage of myocardial damage, whereas the chang...

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