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Transthoracic echocardiography for evaluation of hypertensive heart disease
1Department of Internal Medicine, Cardiovascular Division, University of Iowa, Iowa City 52242.
Insights
Systemic arterial hypertension can cause left ventricular hypertrophy (LVH), potentially harming heart function despite initial protective roles. Echocardiographic methods for measuring LV mass and its changes with treatment are discussed.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Systemic arterial hypertension affects millions, often leading to left ventricular hypertrophy (LVH).
- While LVH may initially be protective against hypertension, it is increasingly linked to adverse cardiac outcomes.
- These include coronary circulation abnormalities, arrhythmias, and impaired cardiac muscle function.
Purpose of the Study:
- To review transthoracic echocardiographic methods for measuring left ventricular mass.
- To discuss the potential advantages and disadvantages of different echocardiographic techniques.
- To explore the controversy surrounding serial LV mass measurements during antihypertensive therapy.
Main Methods:
- Review of existing literature on left ventricular hypertrophy and echocardiography.
- Analysis of transthoracic echocardiographic techniques for LV mass assessment.
- Discussion of studies examining LV mass changes with antihypertensive treatments.
Main Results:
- LVH in hypertension is associated with impaired coronary vasodilator reserve and altered cardiac function.
- Transthoracic echocardiography offers various methods for LV mass measurement, each with pros and cons.
- The prognostic significance of serial LV mass measurements in hypertensive patients receiving treatment remains debated.
Conclusions:
- Left ventricular hypertrophy in hypertension presents a complex clinical picture with potential disadvantages.
- Accurate measurement of LV mass using echocardiography is crucial for risk stratification.
- Further research is needed to standardize LV mass assessment and clarify its role in guiding antihypertensive therapy.
Abstract:
Systemic arterial hypertension is a common malady in the United States, with as many as 58 million persons having a diagnosis of hypertension. Left ventricular hypertrophy (LVH), which develops as a response to the elevated afterload, may be viewed as necessary and protective. However, many recent studies have demonstrated that significant abnormalities of the coronary circulation occur with LVH. These include impaired vasodilator reserve, altered autoregulation, increased tendency to ventricular arrhythmias, and increased infarct size. In addition, adverse effects directly on cardiac muscle which includes decreased contractility, and altered diastolic function may also be present. Therefore, the presence or absence of LVH may predict outcome in addition to hypertension alone. In this review I will discuss potential advantages and disadvantages of each transthoracic echocardiographic method of measuring LV mass. I will also discuss the controversy surrounding serial measurements of LV mass with antihypertensive therapies.