R-Wave Peak Time and Subclinical Left Ventricular Dysfunction in Hypertensive Patients: Insights From Speckle-Tracking Echocardiography.

Background: Hypertension (HT) is one of the most common causes of myocardial dysfunction. Although early detection of myocardial impairment remains challenging, left ventricular global longitudinal strain (LV-GLS) is a sensitive echocardiographic parameter that can identify subclinical myocardial damage. However, its application is limited in routine clinical settings. R-wave peak time (RWPT) is a simple and widely available electrocardiographic parameter that may reflect intramyocardial conduction delay and early structural remodeling. This study aimed to investigate the association between RWPT and LV-GLS in patients with HT.

Methods: This prospective study included 403 patients with a confirmed diagnosis of HT. All participants underwent transthoracic echocardiography and 12-lead surface ECG. LV-GLS was assessed using speckle-tracking echocardiography. ECG images were digitized and analyzed using ImageJ software, and RWPT was defined as the interval from the onset of the QRS complex to the peak of the R-wave.

Results: Patients were divided into two groups according to their LV-GLS value of -15.9%, which is defined as the cutoff value of myocardial impairment. Patients with a lower LV-GLS had significantly longer RWPT and QRS durations. In multivariate analysis, RWPT was found to be an independent predictor of impaired LV-GLS (OR: 1.085; 95% CI: 1.056-1.114; P < 0.001). ROC analysis demonstrated an AUC of 0.715 (95% CI: 0.665-0.765; P < 0.001) with a sensitivity of 64.9% and a specificity of 67.7% at a cutoff value of 45.5 ms.

Conclusions: RWPT may serve as a practical, accessible, and sensitive electrocardiographic marker for detecting subclinical myocardial dysfunction in patients with HT.