Assessing cardiac contractility in hypertension with heart failure with preserved ejection fraction: the value of left ventricular strain

Aim: Hypertension (HTN) is a major cause of heart failure but the precise pathways by which HTN leads to heart failure are not resolved. Newer echocardiographic techniques permit assessment of myocardial contraction in different orientations defining left ventricular (LV) shortening as percentage longitudinal, circumferential and radial strain. Methods: A systematic search was conducted of Medline and Embase. The search was conducted from the inception of each database on June 30, 2022. Search terms “left ventricular strain” or speckle tracking AND heart failure with preserved ejection fraction or diastolic dysfunction AND HTN. Results: Six studies were identified and subject to detailed review. LV ejection fraction (LVEF) was not significantly different in patients with heart failure with preserved ejection fraction (HFpEF) and HTN compared to individuals with or without HTN. Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly (P < 0.0001) different (lower) in patients with HFpEF and HTN compared to patients with HTN without HFpEF and control individuals without HTN or other conditions. In contrast, global radial strain (GRS) was not significantly (P < 0.054) different in patients with HFpEF and HTN compared to individuals without HTN or other conditions. GRS was significantly (P < 0.01) different in individuals with HFpEF and HTN compared to individuals with HTN. Conclusions: Assessment of LV strain is an important advance in the assessment of LV function in patients with HTN and HFpEF as it identifies patients with reduced LV strain while there was no difference in LVEF. GLS and GCS provide the best separation between patients with HFpEF and HTN compared to individuals with HTN without HFpEF. This study advances the possibility of redefining the classification of heart function and heart failure for patients with HTN by either classifying patients mainly by LV strain or sub-classifying patients with HTN and HFpEF by LV strain.