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[Echocardiographic evaluation of ventricular hypertrophy]
Giovanni de Simone1, Vittorio Palmieri
1Laboratorio di Ecocardiografia, Dipartimento di Medicina Clinica e Sperimentale, Nuovo Policlinico, Università Federico II, Napoli. echocardio@unina.it
Insights
Quantitative echocardiography assesses left ventricular (LV) abnormalities for cardiovascular risk. Normalizing LV mass by height to the power of 2.7 better identifies high-risk individuals than other methods.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Quantitative echocardiography is crucial for evaluating left ventricular (LV) geometry and systolic function.
- Key measures like LV diameter and wall thickness inform about hemodynamic alterations.
- M-mode echocardiography is ideal but not always feasible, necessitating alternative methods.
Purpose of the Study:
- To evaluate the utility of quantitative echocardiography in assessing cardiovascular risk.
- To determine the optimal method for indexing LV mass for accurate risk stratification.
- To investigate the association between LV mass, body size, and cardiovascular risk phenotypes.
Main Methods:
- Utilizing quantitative echocardiography to measure LV geometry and systolic function.
- Calculating LV mass using two-dimensional imaging when M-mode is suboptimal.
- Indexing LV mass to body size, specifically exploring normalization to height (m^2.7).
Main Results:
- LV mass indexed to height (m^2.7) identifies a greater proportion of individuals at high cardiovascular risk.
- Increased LV mass for hemodynamic compensation is not clearly linked to elevated risk.
- Disproportionately high LV mass relative to body size indicates a high cardiovascular risk phenotype, independent of hypertension.
Conclusions:
- Quantitative echocardiography provides essential data for cardiovascular risk stratification.
- Indexing LV mass to height (m^2.7) is a superior method for identifying high-risk individuals.
- An inappropriately high LV mass phenotype signifies increased cardiovascular risk, even without hypertension.
Abstract:
Quantitative echocardiography is the gold standard for the evaluation of abnormalities in left ventricular (LV) geometry and systolic function, information very important for risk stratification, and also applicable in clinical practice when some conditions are met. Few primary measures (LV diameter, septal and posterior wall thickness) provide a valuable information which fully represents the type and degree of hemodynamic alteration. These measures should be collected ideally by M-mode tracings, but often M-mode examination cannot be performed. When M-mode is suboptimal, LV mass can be computed using two-dimensional imaging and the formulas used for M-mode. LV mass is expressed as an index normalized for some measure of body size. Normalization for height in meters to the power 2.7 can identify a higher proportion of individuals at high cardiovascular risk and provides a greater attributable risk than other methods of indexation. When LV hypertrophy develops to provide sufficient strength to compensate for hemodynamic overload, the increase in LV mass is not clearly associated with increased cardiovascular risk. In contrast, individuals with LV mass inappropriately high as compared to the value sufficient to compensate for hemodynamic load at a given body size present with a phenotype characterized by high cardiovascular risk, even in the absence of arterial hypertension.