Do diurnal changes in blood pressure affect myocardial work indices?

Conventional echocardiographic parameters such as left ventricular (LV) end-diastolic/end-systolic volume and LV ejection fraction (LVEF) are considered reliable indicators to identify the outcome and risk of cardiovascular events in a wide range of clinical settings. 2,3 Despite the fact that LVEF derived from 2D calculation according to the modified Simpson method has long been considered as the most sensitive parameter of LV systolic function with high prognostic value, it has a number of inherent limitations that significantly reduce its capacity to show real LV performance. [...]subclinical LV systolic dysfunction usually cannot be unmasked by LVEF. 5 The recently developed 2D and 3D speckle tracking echocardiography (a technique based on the analysis of interference patterns and acoustic reflections of myocardial motion and deformation) represents a valuable tool for the detection of subtle systolic dysfunction (which is of particular clinical interest in the hypertensive setting), and allows estimation of myocardial strain components. Among parameters of LV mechanics, global longitudinal strain (GLS) represents a highly sensitive index of systolic function with a greater predictive power for cardiovascular outcomes than LVEF in a large spectrum of cardiovascular diseases including systemic hypertension. 6 Furthermore, GLS has been proven to be a more reproducible parameter than LVEF and significantly less affected by load conditions. 7 The role of myocardial strain and GLS as a new, more sensitive marker of cardiac organ damage in hypertension is currently supported by many individual studies. MW has been shown to be a more sensitive marker of systolic dysfunction than LVEF and GLS in patients with heart failure, coronary artery disease, valvular heart disease, hypertensive heart disease, cardiac dyssynchrony, hypertrophic cardiomyopathy and amyloidosis. 11 The incremental value of MW as a prognostic marker for survival and hospitalizations has been also reported, especially in patients with chronic heart failure. 12 As for hypertension, only a few studies have provided information on subclinical cardiac damage assessed by MW indices so far.