Two-dimensional speckle-tracking echocardiography-based left atrial strain parameters predict masked hypertension in patients with hypertensive response to exercise

Objective We aim to study left atrial (LA) strains in patients with hypertensive response to exercise (HRE) and determine their usefulness in predicting masked hypertension (HT). Methods Ninety-eight normotensive patients who had HRE were included and were divided into two groups after masked HT had been diagnosed by ambulatory blood pressure monitoring. Conventional echocardiographic parameters and two-dimensional speckle-tracking echocardiography-based LA strain parameters were compared. Results Patients with masked HT have higher left ventricle mass index (LVMI) (88.1 +/- 11.3 vs. 82.5 +/- 8.7 g/m(2), P<0.05), left atrium maximum volume index (LAVI) (34.5 +/- 5.1 vs. 30.2 +/- 5.6 ml/m(2), P<0.001), lower global longitudinal LA strain during ventricular systole (GLAs-res) (32.5 +/- 8.9 vs. 40.2 +/- 9.1%, P<0.001), and lower global longitudinal LA strain during late diastole (GLAs-pump) (15.8 +/- 4.1 vs. 18.1 +/- 5.8%, P<0.05). In univariate analysis, a good negative correlation was found between GLAs-res versus LAVI (r=-0.451, P<0.001), GLAs-res versus LVMI (r=-0.457, P<0.001) and a moderate negative correlation was present between GLAs-pump versus LAVI (r=-0.317, P<0.001) and GLAs-pump versus LVMI (r=-0.288, P<0.05). GLAs-res and LAVI were found to be independent predictors of masked HT. Receiver-operating characteristic analysis was carried out. Area under the curve to predict masked HT was 0.729 (95% confidence interval: 0.623-0.832, P<0.001). GLAs-res less than 33.1% predicted masked HT with 73% sensitivity and 61.5% specificity. Conclusion LA strain parameters were impaired in patients with masked HT and can be used to predict the presence of masked HT in patients with HRE. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.