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Detection of irregular patterns of myocardial contraction in patients with hypertensive heart disease: a two-dimensional ultrasound speckle tracking study

Goebel, Björna,*; Gjesdal, Olab,*; Kottke, Danielaa; Otto, Sylviaa; Jung, Christiana; Lauten, Alexandera; Figulla, Hans R.a; Edvardsen, Thorb; Poerner, Tudor C.a

doi: 10.1097/HJH.0b013e32834bdd09
Original papers: Heart

Objective To evaluate the effect of myocardial hypertrophy in patients with arterial hypertension on regional myocardial function and left ventricular twist.

Methods Eighty patients with normal coronary angiograms and ejection fraction higher than 55% were divided according to left ventricular mass indexed to body height (LVMH) into a group with and without left ventricular hypertrophy (LVH). The absolute values and time-to-peak values of overall strain (S), systolic (SRS) and early diastolic strain rate (SRE) were measured in longitudinal, circumferential and radial directions using two-dimensional speckle tracking echocardiography. Left ventricular twist and twist rate curves were calculated from rotation curves obtained from apical and basal parasternal short-axis planes.

Results In the patient group with LVH, SRS and SRE, quantified in longitudinal and circumferential direction, were lower compared with the group without LVH. In addition, systolic twist rate and diastolic untwist rate were significantly lower in this patient group, too. No differences between patients groups were found for peak overall S measured in any direction or left ventricular twist. LVMH correlated significantly with longitudinal SRS (r = 0.48, P < 0.001), longitudinal SRE (r = −0.48, P < 0.001), systolic twist rate (r = 0.37, P = 0.006) and diastolic untwist rate (r = −0.27, P = 0.046).

Conclusion In conclusion, LVH in patients with arterial hypertension predominantly affected longitudinal and circumferential deformation rate. Moreover, LVH resulted in a significant reduction of systolic twist rate and diastolic untwist rate, whereas overall left ventricular twist angle was not influenced by LVMH.

aDivision of Cardiology, First Department of Medicine, University Hospital of Jena, Jena, Germany

bDepartment of Cardiology, Rikshospitalet University Hospital, University of Oslo, Oslo, Norway

*Björn Goebel and Ola Gjesdal contributed equally to the writing of this article.

Correspondence to Priv.-Doz. Dr med. Tudor C. Poerner, Division of Cardiology, First Department of Medicine, University Hospital of Jena, Erlanger Allee 101, D-07740 Jena, GermanyTel: +49 3641 9324113; fax: +49 3641 9324102; e-mail:

Abbreviations: DT, deceleration time of early transmitral velocity; E, early diastolic transmitral velocity; E′, early diastolic velocity of the septal and lateral mitral annulus; IVRT, isovolumic relaxation time; LVEDd, left ventricular end-diastolic diameter; LVEDP, left ventricular end-diastolic pressure; LVEDs, left ventricular end-systolic diameter; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; LVMH, left ventricular mass indexed to body height; PWTd, end-diastolic posterior wall thickness; RWT, relative wall thickness; S, strain; SD time-to-peak overall S, standard deviation of time-to-peak overall strain values; SRE, early diastolic strain rate; SRS, systolic strain rate

Parts of this work have been already presented at the Annual Conference of the American Heart Association (2008) and the Conference of the European Society of Cardiology (2008 and 2009).

Received 26 July, 2010

Revised 12 June, 2011

Accepted 11 August, 2011

© 2011 Lippincott Williams & Wilkins, Inc.