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The influence of sex on left ventricular strain in hypertensive population

Tadic, Marijanaa; Cuspidi, Cesareb; Celic, Veraa; Ivanovic, Branislavac; Pencic, Biljanaa; Grassi, Guidod,e

doi: 10.1097/HJH.0000000000001838
ORIGINAL PAPERS: Heart and vessels

Objective: The aim of this study was to evaluate the influence of sex on left ventricular mechanics in hypertensive individuals.

Methods: This cross-sectional study included 171 untreated hypertensive patients and 112 normotensive controls who underwent a 24-h ambulatory blood pressure monitoring and comprehensive echocardiographic examination including strain assessment.

Results: Hypertensive women and men had significantly lower left ventricular global longitudinal and circumferential strains than their normotensive counterparts. Left ventricular global longitudinal strain was lower in hypertensive men than in women (−19.8 ± 2.2 vs. −17.9 ± 2.1%; P < 0.01). Left ventricular global circumferential strain was also reduced in hypertensive men in comparison with women (−21.0 ± 2.5 vs. −18.7 ± 2.3%; P < 0.01). The difference in left ventricular radial strain was not discovered between hypertensive women and men. Furthermore, left ventricular twist was significantly higher in hypertensive women than in hypertensive men (21.9 ± 4.1° vs. 20.6 ± 3.8°; P = 0.034). Female sex and arterial hypertension, and also their interaction, were associated with lower left ventricular mass index, increased left ventricular global longitudinal, and circumferential strains and increased left ventricular twist compared with hypertensive men.

Conclusion: Left ventricular longitudinal and circumferential strains were significantly reduced in hypertensive patients. However, the changes are more pronounced in hypertensive men than in women. Sex has a significant effect on the association between hypertension, and longitudinal and circumferential strain.

aUniversity Clinical Hospital Center ‘Dr Dragisa Misovic – Dedinje’, Department of Cardiology, Belgrade, Serbia

bUniversity of Milan-Bicocca and IstitutoAuxologicoItaliano, Clinical Research Unit, Meda, Italy

cClinical Centre of Serbia, Cardiology Clinic, Koste Todorovica 6, Belgrade, Serbia

dDepartment of Medicine and Surgery, University Milano-Bicocca

eIRCCS Multimedica Sesto San Giovanni, Milan, Italy

Correspondence to Marijana Tadic, MD, PhD, University Clinical Hospital Center ‘Dr Dragisa Misovic – Dedinje’, Cardiology Department, Heroja Milana Tepica 1, 11000 Belgrade, Serbia. Tel: +38 1658107085; fax: +38 1112411464; e-mail:

Abbreviations: BP, blood pressure; BSA, body surface area; LVEDD, left ventricular end-diastolic diameter; PWT, posterior wall thickness

Received 1 April, 2018

Revised 6 May, 2018

Accepted 28 May, 2018

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