Strain Rate Imaging Differentiates Hypertensive Cardiac Hypertrophy from Physiologic Cardiac Hypertrophy (Athlete's Heart)

Background: This study sought to determine whether strain rate imaging could distinguish between individuals with hypertensive left ventricular hypertrophy (LVH) and those with strength-training athletic LVH. Methods: In all, 108 participants (30 hypertensive LVH, 30 strength-training LVH, 48 control) were enrolled. In addition to a baseline echocardiogram, strain, peak systolic strain rate (SR_S), peak early diastolic strain rate (SR_E), and peak late diastolic strain rate values were compared in the apical 4-chamber view. Results: Athletes had no significant differences in strain, SR_S, SR_E, or peak late diastolic strain rate compared with control subjects (P = .11, .99, .85, and .09, respectively). Individuals with hypertensive LVH had significantly decreased strain, SR_S, and SR_E (-16.8 ± 3.2%, -0.99 ± 0.15 s^-1, and 1.54 ± 0.40 s^-1, respectively) compared with control subjects (-21.7 ± 3.5%, -1.31 ± 0.27 s^-1, and 2.35 ± 0.57 s^-1, respectively; all P < .0001). Conclusion: Hypertensive LVH has significant longitudinal strain, SR_S, and SR_E reductions versus control. The lack of these reductions in athletes suggests that strain rate imaging may have clinical use in discerning the physiologic LVH state.