Prognostic Implications of LV Strain Risk Score in Asymptomatic Patients With Hypertensive Heart Disease

Saito, Makoto; Khan, Faisal; Stoklosa, Ted; Iannaccone, Andrea; Negishi, Kazuaki; Marwick, Thomas H.

doi:10.1016/j.jcmg.2015.09.027

Cited by 97 publications

(71 citation statements)

References 33 publications

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“…The early diastolic longitudinal strain rate was remarkably attenuated compared to the healthy siblings. Previous studies have suggested that the development of hypertension and increased afterload are associated with a reduction in GLS . Our data suggest the presence of a genetic servo mechanism by which, during early stages of HHD, the genetic blueprint can conserve the global cardiac contraction towards a set normal value at end‐systole, although acquired factors associated with the development of hypertension start changing LV relaxation mechanics within the early diastolic phase.…”

Section: Discussionmentioning

confidence: 52%

Genetically determined pattern of left ventricular function in normal and hypertensive hearts

Kovács

Molnár

Kolossváry

et al. 2018

J of Clinical Hypertension

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We sought to assess the inheritance of left ventricular (LV) function using speckle-tracking echocardiography and the impact of hypertension on modifying the genetically determined pattern of contraction in a population of twins. We recruited 92 Caucasian twin pairs, including 74 hypertensive (HTN) siblings. Beyond standard echocardiographic protocol, a speckle-tracking analysis was performed, including global longitudinal strain (GLS). Systolic function, as assessed by ejection fraction, showed moderate heritability (61%); however, GLS showed higher and dominant heritability (75%). Heterogeneity models revealed that there were no differences between the HTN and non-HTN subjects regarding the heritability of GLS. However, the heritability estimates of diastolic function parameters, including early diastolic strain rate, were low. LV systolic biomechanics is highly heritable. GLS shows dominant heritability, despite the presence of early-stage hypertensive heart disease. Early diastolic parameters are rather determined by environmental factors. These findings suggest the presence of a genetic framework that conserves systolic function despite the expression of diastolic dysfunction and may underlie the phenotypic progression towards heart failure with preserved ejection fraction.

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Section: Discussionmentioning

confidence: 52%

Genetically determined pattern of left ventricular function in normal and hypertensive hearts

Kovács

Molnár

Kolossváry

et al. 2018

J of Clinical Hypertension

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“…Recently, the association of reduced strain with poor prognosis in hypertension was reported by Lee et al 37 . Despite the established role of LVEF and increased LV mass for higher incidence of cardiovascular risk 20,32,35,38 , more and more studies showed strain (especially LV longitudinal strain) was superior and incremental for assessing the relation with major adverse cardiac events (MACE) [39][40][41] . The normal reference values of strain parameters by using CMR-FT varied in different study.…”

Section: Discussionmentioning

confidence: 99%

Early and Quantitative Assessment of Myocardial Deformation in Essential Hypertension Patients by Using Cardiovascular Magnetic Resonance Feature Tracking

Liu

Wang

Pan

et al. 2020

Sci Rep

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the aims of the study were to identify subclinical global systolic function abnormalities and evaluate influencing factors associated with left ventricular (LV) strain parameters in hypertensive subjects using cardiovascular magnetic resonance imaging feature tracking (CMR-FT). The study enrolled 57 patients with essential hypertension (mean age: 43.04 ± 10.90 years; 35 males) and 26 healthy volunteers (mean age: 38.69 ± 10.44 years; 11 males) who underwent clinical evaluation and CMR examination. Compared with controls, hypertensive patients had significantly impaired myocardial strain values while ejection fraction (EF) did not differ. After multivariate regression analyses adjustment for confounders, the global radial strains (GRS) was independently associated with the mean arterial pressure (MAP) and left ventricular mass index (LVMI) (β = −0.219, p = 0.009 and β = −0.224, p = 0.015, respectively; Adjusted R 2 = 0.4); the global circumferential strains (GCS) was also independently associated with the MAP and LVMI (β = 0.084, p = 0.002 and β = 0.073, p = 0.01, respectively; Adjusted R 2 = 0.439); the global longitudinal strains (GLS) was independently associated with the Age and MAP (β = 0.065, p = 0.021 and β = 0.077, p = 0.009, respectively; Adjusted R 2 = 0.289). Myocardial strain can early detect the myocardial damage and may be an appropriate target for preventive strategies before abnormalities of EF. Essential hypertension is defined as a rise in blood pressure which can increase risks for cerebral, cardiac, and renal events with unknown reason 1. Hypertension remains deserving for more attention since it is a potent risk factor for cardiovascular diseases and it may brings considerable morbidity and mortality 1-4. Given the prevalence of hypertension in the population, early identifying subclinical left ventricular (LV) systolic dysfunction among hypertensive subjects might have an important role in assessing the prognosis and choosing treatment strategies. Strain imaging has emerged as a sensitive and powerful tool to detect early and subtle myocardial dysfunction in various cardiac diseases, and may provide a novel method for LV risk assessment in hypertensive patients 5-7. Myocardial strain was first used by cardiovascular magnetic resonance (CMR) tagging in 1988 8. CMR tagging has been the most available and reproducible method to quantify the myocardial deformation and remains the reference standard for evaluating myocardial strain 9,10. However, CMR tagging needs to acquire additional sequences and its post processing is time-consuming. The spatial resolution of tagging is quite low, which is another limitation of tagging. Therefore, CMR tagging has not yet been widely applied in clinical circumstances. Speckle tracking echocardiography (STE) has solved these issues to a large extent, but it is still limited by the observer dependency, signal noise, angle dependency, inadequate acoustic windows and poor image quality 11-13. Cardiovascular magnetic resonance imaging feature tracking (CMR-FT), whic...

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“…[50][51][52] Reduction of GLS during follow-up was found to be an independent predictor of MACE (death and admission for heart failure, myocardial infarction, and strokes) in a recent study. 53 Compared with patients with HCM, HHD does not present a typical pattern and GLS seem to be less compromised ( Figure 2). 43 Finally, athletes' hearts present myocardial hypertrophy due to morphological and functional changes.…”

Section: Strainimagingfordifferentialdiagnosisof Increasedwallthickmentioning

confidence: 95%

“…Several studies showed a reduced GLS even in patients who still have normal LV geometry with a major decrease in hypertrophic heart and a compensatory GCS and twist . Reduction of GLS during follow‐up was found to be an independent predictor of MACE (death and admission for heart failure, myocardial infarction, and strokes) in a recent study . Compared with patients with HCM, HHD does not present a typical pattern and GLS seem to be less compromised (Figure ) …”

Section: Echocardiographic Myocardial Strain Imagingmentioning

confidence: 99%

Echocardiographic advances in hypertrophic cardiomyopathy: Three‐dimensional and strain imaging echocardiography

et al. 2018

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In the recent past, new ultrasound technologies, such as three-dimensional echocardiography and strain imaging echocardiography, raised up in clinical practice leading to a better assessment of cardiac morphology and performance. These tools may assess regional cardiac mechanics, detecting clinical and subclinical myocardial dysfunction in different settings such as ischemic heart disease, cardiomyopathies, and heart valve diseases. Interesting results derive from patients affected from hypertrophic cardiomyopathy (HCM). Particularly, the mentioned techniques are progressively redefining the role of echocardiography in diagnostic evaluation of HCM variants such as apical HCM, detection of the underlying conditions of increased wall thickness, assessment of subclinical myocardial impairment, and potentially refine risk stratification and prognosis. In this review, we describe the clinical uses of these methodologies and the perspective application in HCM patients.

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Prognostic Implications of LV Strain Risk Score in Asymptomatic Patients With Hypertensive Heart Disease

Abstract: GLS and its deterioration are associated with MACE in asymptomatic hypertensive heart disease. A risk score incorporating strain was useful for predicting risk of MACE.

Cited by 97 publications

References 33 publications

Genetically determined pattern of left ventricular function in normal and hypertensive hearts

Genetically determined pattern of left ventricular function in normal and hypertensive hearts

Early and Quantitative Assessment of Myocardial Deformation in Essential Hypertension Patients by Using Cardiovascular Magnetic Resonance Feature Tracking

Echocardiographic advances in hypertrophic cardiomyopathy: Three‐dimensional and strain imaging echocardiography

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