Related Experiment Videos
Pathophysiologic assessment of hypertensive heart disease with echocardiography
Insights
Echocardiography detects early left ventricular changes in hypertension, even before electrocardiogram abnormalities appear. This non-invasive method assesses cardiac dimensions and function in hypertensive heart disease.
Area of Science:
- Cardiology
- Medical Imaging
- Hypertension Research
Background:
- Assessing pathophysiologic changes in systemic hypertension is challenging due to limitations of invasive left ventricular studies.
- Echocardiography offers a non-invasive approach to evaluate cardiac dimensions and function in hypertensive heart disease.
Purpose of the Study:
- To assess cardiac dimensions and function using echocardiography in patients with varying stages of hypertensive heart disease.
- To correlate echocardiographic findings with electrocardiographic and chest X-ray criteria in hypertensive patients.
Main Methods:
- Echocardiography was used to study 31 hypertensive patients and 14 age-matched normotensive controls before antihypertensive therapy.
- Hypertensive patients were classified into three groups based on electrocardiogram and chest X-ray findings.
- Mean arterial pressure, left ventricular mass, wall thickness, ejection fraction, fractional fiber shortening, and cardiac index were measured.
Main Results:
- Mean arterial pressure increased progressively across the hypertensive groups.
- Left ventricular mass, posterior wall, and septal thickness significantly increased with higher arterial pressure.
- Ejection fraction and fractional fiber shortening decreased significantly in patients with left atrial abnormality and left ventricular hypertrophy.
Conclusions:
- Echocardiography can identify increased left ventricular mass in early hypertensive heart disease.
- Echocardiographic findings correlate with the severity of hypertension and electrocardiographic criteria.
- Non-invasive echocardiography is valuable for assessing cardiac changes in hypertensive heart disease.
Abstract:
Assessment of the pathophysiologic changes associated with systemic hypertension has been limited by difficulty in justifying invasive studies of the left ventricle. Echocardiography, because it is notinvasive, offers an attractive method of assessing cardiac dimensions and function in hypertensive heart disease. Fourteen age-matched normotensive subjects and 31 patients with hypertension (but without clinical evidence of coronary artery disease) were studied before receiving any antihypertensive therapy. The patients with hypertension were classified into three groups on the basis of previously established electrocardiographic and chest X-ray criteria: group I, normal electrocardiogram and chest roentgenogram (13 patients); group II, left atrial abnormality by electrocardiogram and a normal chest roentgenogram (8 patients); and group III, left ventricular hypertrophy by electrocardiogram or chest roentgenogram, or both (10 patients). Mean arterial pressure increased significantly from group I to group II and from group II to group III (P is less than 0.01), and this increase was associated with a similar progressive increase in left ventricular mass assessed with echocardiogram (P is less than 0.01). A significant increase was also found in both posterior wall and septal thickness in groups II (P is less than 0.05) and III (P is less than 0.01). In association with this increased mass a significant decrease in ejection fraction and fractional fiber shortening was demonstrated in groups II (P is less than 0.05) and III (P is less than 0.01) although cardiac index was reduced only in group III (P is less than 0.05). Thus, increased ventricular mass can be identified with echocardiography at an early stage of hypertensive heart disease when only left atrial abnormality is identifiable with electrocardiographic criteria and decreased left ventricular performance occurs with increasing arterial pressure and left ventricular hypertrophy.