Impact of Hypertension on Left Ventricular Pressure-Strain Loop Characteristics and Myocardial Work

Hypertension is a major risk factor for cardiovascular disease. Pressure-strain loop analysis has recently been introduced as a clinical tool to quantify the pumping efficiency of the left ventricle (LV), as an alternative to the classical pressure-volume loop analysis. The aims of this study were to: (i) combine global longitudinal strain (GLS) from 3D transthoracic echocardiography (TTE) with LV catheter pressure measurements to compute myocardial work indices-namely the global work index (GWI), wasted work index (WWI), and constructive work index (CWI); and (ii) compare work indices between normotensive and hypertensive patients, with further categorisation into medicated and non-medicated sub-groups. 3D TTE and LV pressures were measured in 143 patients (49 females), with 53, 42, 28, and 20 patients in groups of controlled hypertensives, uncontrolled hypertensives, normotensive controls, and untreated hypertensives (e.g., recent diagnoses), respectively. Statistically significant differences (p < 0.05) in GWI and CWI were observed between patients with high blood pressure and the normotensive controls, with largest GWI values in the untreated hypertensive group (1954 +/- 322 mmHg%), and smallest values in the controlled hypertensive group (1531 +/- 449 mmHg%). Examining LV energetics using pressure-strain (GLS) loop analysis may provide greater understanding into cardiac function and disease progression in hypertension, and help inform appropriate treatment strategies for cardiac patients with pathologies such as heart failure.