Hypertensive heart disease beyond left ventricular hypertrophy: Are we ready for echocardiographic strain evaluation in everyday clinical practice?

Hypertension-induced left ventricular (LV) remodeling is a well known entity that has usually been studied with traditional echocardiographic techniques. In the last decade echocardiographic methods are focused on evaluation of heart mechanics. The strain assessment is considered as part of comprehensive echocardiographic examination. Nevertheless, LV strain and particularly longitudinal strain was proofed as a significant independent predictor of cardiovascular and total morbidity and mortality, stronger than LV ejection fraction. Considering the fact that hypertensive heart disease represents one of the most important risk factors for the development of heart failure with preserved ejection fraction, one should be careful and accurate in identifying subtle signs of cardiac dysfunction. The early detection of cardiac dysfunction by conventional echocardiographic methods is often not possible. The aim of the current article is to overview the main principles of LV mechanics and summarize the current knowledge and clinical significance of LV strain in hypertensive patients.