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Although ejection fraction (EF) remains the standard metric for assessing left ventricular function, it often fails to detect early dysfunction. Speckle-tracking echocardiography (STE) provides a more sensitive approach to identifying subclinical myocardial strain changes before EF declines. This cross-sectional, case-control study evaluated 90 participants divided into three groups: 30 healthy controls (Group I), 40 hypertensive patients without LVH (Group II), and 20 hypertensive patients with LVH (Group III). All underwent clinical evaluation, conventional echocardiography, and 2D-STE. Results showed that Group III had significantly greater septal and posterior wall diastolic thickness (p\u2009=\u20090.001) and higher LV mass index (p\u2009=\u20090.001) compared to Groups I and II. 2D-STE revealed reduced apical (AP2Ls, AP3Ls) and global longitudinal strain (GLS) in Groups II and III versus controls. Basal and mid-segment strains were also lower in disease groups, with mid-inferolateral segments showing more pronounced impairment in Group III. These findings highlight that Group III exhibited the most severe structural and functional cardiac alterations. The study demonstrates the superiority of 2D-STE over conventional echocardiography in detecting subclinical LV dysfunction in hypertensive patients, particularly those with LVH, through impaired longitudinal strain measurements. Early integration of 2D-STE into clinical practice could facilitate timely interventions to mitigate myocardial remodeling and heart failure progression.<\/jats:p>","DOI":"10.1038\/s41371-025-01100-x","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:00:14Z","timestamp":1765821614000},"page":"171-179","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Subclinical left ventricular systolic impairment in hypertensive patients: insights from 2d speckle-tracking echocardiography"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1506-9185","authenticated-orcid":false,"given":"Mohammad","family":"Shafiq","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"M. 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