Diagnostic Value of Two-Dimensional Speckle Tracking Echocardiography in Assessing Cardiac Function in Elderly Patients with Hypertensive Heart Disease.

BACKGROUND

Hypertensive heart disease (HHD) in older adults is characterized by structural remodeling and subtle functional impairment that may escape conventional echocardiography. This study aimed to determine the diagnostic value of two-dimensional speckle tracking echocardiography (2D-STE)-derived left atrial strain rates for functional assessment in elderly patients with HHD.

METHODS

In this retrospective, single-center cohort, 236 patients aged ≥65 years were enrolled (January 2023-January 2025): 118 with echocardiographic HHD and 118 age-matched hypertensive controls without structural abnormalities. Transthoracic echocardiography with 2D-STE quantified mean peak left atrial strain rates in late diastole (mSRa), early diastole (mSRe), and systole (mSRs). Elderly HHD patients were stratified by New York Heart Association (NYHA) class. Group comparisons used t-tests, and receiver operating characteristic (ROC) curves with area under the curve (AUC) evaluated discrimination.

RESULTS

Compared with controls, the HHD group had larger left ventricular end-diastolic diameter (LVEDD 60.29 ± 5.26 vs 48.17 ± 5.46 mm; P<0.001), lower left ventricular ejection fraction (LVEF 51.10 ± 7.25% vs 61.21 ± 4.96%; P<0.001), and impaired atrial mechanics (mSRa -2.20 ± 0.27 vs -2.75 ± 0.30 s- 1; P<0.001; mSRe -2.29 ± 0.33 vs -1.90 ± 0.38 s- 1; P<0.001; mSRs 1.34 ± 0.30 vs 2.15 ± 0.31 s- 1; P<0.001). Within HHD, NYHA III-IV showed worse strain than NYHA I-II (eg, mSRa -1.90 ± 0.26 vs -2.48 ± 0.23 s- 1; P<0.001). ROC analysis demonstrated excellent discrimination of functional severity: AUC 0.916 for mSRa (cut-off -2.367 s- 1; sensitivity 96.8%; specificity 76.7%), AUC 0.876 for mSRe (-2.302 s- 1; 91.6%; 65.0%), and AUC 0.881 for mSRs (1.361 s- 1; 92.5%; 68.7%) (all P<0.001).

CONCLUSION

In elderly HHD, 2D-STE-derived atrial strain rates (mSRa, mSRe, mSRs) are significantly impaired, correlate with NYHA class, and provide high diagnostic accuracy for differentiating mild versus severe functional limitation. These indices may serve as sensitive, non-invasive markers to support early detection and clinical stratification in this population. Prospective studies are needed to establish prognostic utility.