it reflects increased LV mass, stiff LV / low LV compliance and long IVRT, these may reduce the TDI

Thanks for your comments and I totally agree with you. But there are instances the reduced myocardial velocities been reported as early signs of myocardial dysfunction. In this particular case the left heart coronary angiogram performed -normal coronaries.

Patients with hypertension characteryzed not only increased LV index and stiffness of walls LV. On the reduction of myocardial systolic velocity also affects elongation time of isovolumetric diastole, maily IVCT and shortening ET, which inderecty affects on the systolic function.

Thanks for your insight Leszek. Does it imply that Global longitudinal Strain will also show abnormalities . But in this particular case the LV wall thickness and mass was within the normal range indexed to body surface area (BSA). It would be interesting to know the pattern of Global longitudinal strain in hypertensive heart. Any insight on this would be of great help. Thanks in advance.

Reduced mitral annular velocities could also mean - myocarditis.

Thanks much for ur comments and insight. Really appreciate it.

Dear Meen Sumathy,

Much now has been learnt about diastolic dysfunction during this time..

Particularly for this patient

2 additional mechanism can be considered.

1.Mycardial fibrosis (we need to know about comorbidity like obesity, sleep apnea etc)

2. Coronary microvascular disease.

Thanks for your valuable insight.