Left Ventricular and Left Atrial Mechanics in Resistant Hypertension—The Role of Two-Dimensional Speckle Tracking Echocardiography

Akhmimi, A, Lip, GYH ORCID: 0000-0002-7566-1626, Sprung, T ORCID: 0000-0002-2666-4986, Oxborough, D ORCID: 0000-0002-1334-3286 and Shantsila, A (2026) Left Ventricular and Left Atrial Mechanics in Resistant Hypertension—The Role of Two-Dimensional Speckle Tracking Echocardiography. Echocardiography, 43 (6). ISSN 0742-2822

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Abstract

Resistant hypertension (RH) is associated with a high burden of cardiovascular morbidity and mortality. Early detection of subclinical myocardial dysfunction is essential for risk stratification and timely therapeutic intervention. Speckle tracking echocardiography (STE) is an advanced imaging technique that enables sensitive assessment of myocardial mechanics and can identify subtle functional abnormalities before changes in conventional parameters such as ejection fraction become apparent. This review summarizes the current evidence on the role of STE in evaluating left ventricular (LV) and left atrial (LA) myocardial deformation in patients with uncontrolled hypertension and RH. Available data indicate that STE-derived indices, particularly LV global longitudinal strain and LA phasic strain parameters, are frequently impaired in these populations, reflecting early myocardial dysfunction. However, other components of myocardial deformation, including circumferential strain, radial strain and twist mechanics, remain insufficiently investigated in patients with RH. In addition, the absence of multimodality imaging validation and incomplete exclusion of coexisting coronary artery disease in several studies represent important limitations. Overall, STE appears to be a valuable tool for the early detection of subclinical LV and LA dysfunction in RH, and may enhance clinical risk stratification. Further well-designed prospective studies incorporating comprehensive strain analysis and multimodality imaging are required to better define its prognostic and therapeutic implications.

Item Type:	Article
Uncontrolled Keywords:	echocardiography; myocardial mechanics; resistant hypertension; speckle tracking echocardiography; strain imaging; uncontrolled hypertension; Heart Atria; Heart Ventricles; Humans; Ventricular Dysfunction, Left; Hypertension; Echocardiography; Elasticity Imaging Techniques; Global Longitudinal Strain; echocardiography; myocardial mechanics; resistant hypertension; speckle tracking echocardiography; strain imaging; uncontrolled hypertension; Humans; Hypertension; Ventricular Dysfunction, Left; Echocardiography; Heart Atria; Global Longitudinal Strain; Elasticity Imaging Techniques; Heart Ventricles; 32 Biomedical and Clinical Sciences; 3201 Cardiovascular Medicine and Haematology; Hypertension; Heart Disease - Coronary Heart Disease; Prevention; Biomedical Imaging; Clinical Research; Heart Disease; Cardiovascular; 4.2 Evaluation of markers and technologies; Cardiovascular; 3 Good Health and Well Being; Humans; Hypertension; Ventricular Dysfunction, Left; Echocardiography; Heart Atria; Global Longitudinal Strain; Elasticity Imaging Techniques; Heart Ventricles; 1102 Cardiorespiratory Medicine and Haematology; Cardiovascular System & Hematology; 3201 Cardiovascular medicine and haematology
Subjects:	R Medicine > RC Internal medicine R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice Sport and Exercise Sciences
Publisher:	Wiley
Date of acceptance:	14 May 2026
Date of first compliant Open Access:	14 July 2026
Date Deposited:	14 Jul 2026 13:49
Last Modified:	14 Jul 2026 13:49
DOI or ID number:	10.1111/echo.70515
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29012

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