Author + information
- Maurizio Galderisi, MD∗ ( and )
- Bruno Trimarco, MD
- ↵∗Department of Advanced Biomedical Sciences, Federico II University Hospital, Via Pansini 5, Naples 80131, Italy
We read the CARDIA (Coronary Artery Risk Development in Young Adults) study with interest (1). In 2,479 subjects (average entry age, 25 years), high cumulative exposure (over 25 years) to systolic and diastolic blood pressure (BP) was not associated with left ventricular (LV) ejection fraction but with lower longitudinal systolic and early diastolic strain rates derived by speckle-tracking echocardiography (STE). Few CARDIA subjects had BP exceeding treatment thresholds at any stage, and the BP effect on LV function did not have a specific threshold. In the editorial, Marwick and Venn (2) point out that, because of the recognized prognostic power of strain parameters, the use of STE surpasses the information provided by LV hypertrophy and allows identification of subclinical target organ damage that could make an individualized approach easier.
The CARDIA study data find support in the literature. Young, newly diagnosed hypertensive patients had reduced global longitudinal strain (GLS) compared with both young sedentary control patients and athletes, and the magnitude of GLS was associated with the degree of the estimated LV filling pressure (E/e′ ratio), independent of the afterload burden and LV mass extent (3). Early reduction of GLS was found in borderline pre-hypertensive patients identified on the basis of ambulatory BP monitoring (4). LV longitudinal function, strictly depending on subendocardial fibers, was strongly affected by the presence of myocardial fibrosis (5) (i.e., the main determinant of diastolic dysfunction). Taken together, these observations open important paths for the diagnosis of heart involvement and management of young uncomplicated hypertensive patients. A new era is dawning in which meaningful functional, but also feasible and reproducible, parameters corresponding to longitudinal strain measurements, could extend traditional structural hallmarks such as LV mass and hypertrophy.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2015 American College of Cardiology Foundation