BACKGROUND We hypothesized that deterioration of systolic left ventricular (LV) myocardial deformation exists as an early sign of "isolated" diastolic heart failure in patients with hypertension (HT) and LV hypertrophy (LVH). RESULTS Two-dimensional strain echocardiography was performed in 98 patients with HT and 22 age-matched normal controls. The LV mass index and relative wall thickness were used to assign patients into 3 groups with normal geometry (N-LV, n=31), concentric hypertrophy (C-LVH, n=25), and eccentric hypertrophy (E-LVH, n=42). The LV ejection fraction was preserved (> or =50%) in the 3 HT groups. The mean peak systolic longitudinal, circumferential, and radial strains in the C-LVH group were lower compared to the control and other 2 HT groups. The mean peak systolic strain rates in the 3 directions in the C-LVH group and those in the longitudinal and radial directions in the E-LVH and N-LV groups were lower compared to the control group. In addition, the mean peak systolic circumferential strain rate was lower in the C-LVH group than in the other 2 HT groups. There were no differences in the LV torsion and torsional rate between the control and 3 HT groups. The mean peak systolic circumferential strain was an independent predictor related to LV ejection fraction in all patients. CONCLUSIONS C-LVH caused deterioration of the systolic longitudinal, circumferential, and radial myocardial deformation in patients with HT. LV torsion and circumferential shortening were considered to be compensatory mechanisms for maintaining LV pump function.