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Left heart remodelling in hypertensive patients: a comprehensive echocardiography and computed tomography study
Aleksandra Lange1, Viktoria Palka1,2, Chris Bian1
1Queensland Cardiovascular Group, Brisbane, QLD, Australia.
Insights
Hypertension causes left heart remodelling, assessed by CTCA and TTE. A new LEDA score using four TTE parameters effectively identifies hypertensive heart disease, showing high accuracy.
Area of Science:
- Cardiology
- Medical Imaging
- Hypertension Research
Background:
- Hypertension is a leading cause of cardiovascular disease, often leading to left heart remodelling.
- Assessing cardiac structural and functional changes in hypertension is crucial for risk stratification.
- Ischaemic heart disease can confound assessments of hypertensive heart disease.
Purpose of the Study:
- To evaluate left heart remodelling in patients with hypertension without ischaemic heart disease.
- To compare findings from computed tomography coronary angiography (CTCA) and transthoracic echocardiography (TTE).
- To develop and validate a scoring system for identifying hypertensive heart disease.
Main Methods:
- 178 patients (96 with essential hypertension, 82 controls) underwent CTCA and TTE.
- Transthoracic echocardiography assessed left ventricle (LV) and left atrial (LA) size, function, and remodelling.
- Computed tomography coronary angiography and TTE measured LV and LA diastasis volumes.
- A composite LEDA score was derived from four TTE parameters.
Main Results:
- Hypertensive patients showed a higher prevalence of concentric LV remodelling and altered LA volumes and function.
- The LV diastasis volume/LA diastasis volume ratio was lower in hypertensive patients.
- A novel TTE-derived LEDA score demonstrated high accuracy (AUC=0.772) in distinguishing hypertensive heart disease.
- CTCA-derived LV diastasis volume/LA diastasis volume ratio showed modest accuracy (AUC=0.646).
Conclusions:
- Transthoracic echocardiography, particularly the LEDA score, is effective in defining left heart remodelling in hypertension.
- The LEDA score, incorporating LV dimensions, diastolic function (E/e'), and LA reservoir function, accurately identifies hypertensive heart disease.
- Combined imaging modalities like CTCA and TTE provide comprehensive insights into hypertensive cardiac changes.
Objectives:
This study aimed to assess left heart remodelling changes in hypertension, excluding underlying ischaemic heart disease, utilising computed tomography coronary angiography (CTCA) and transthoracic echocardiography (TTE).
Methods:
A total of 178 patients (mean age 60 ± 9 years, 53% female) were enrolled in the study: Group 1 consisted of patients with essential hypertension (n = 96, Group 1), and Group 2 served as age-matched controls (n = 82, Group 2). All participants underwent both CTCA and TTE. TTE measurements included left ventricle (LV) concentricity and function and left atrial (LA) volume and function. Using both CTCA and TTE, we measured LV diastasis volume (LVdias) and LA diastasis volume (LAdias).
Results:
LV mass index and LV mass/height2.7 were similar in both the groups. However, Group 1 had a higher prevalence of concentric LV remodelling, characterised by a larger mean LV wall thickness, increased relative wall thickness ratio, and a reduced ratio of LV end-diastolic volume (LVED) index to mean wall thickness (55 ± 14 vs. 65 ± 15, p = 0.0007). Group 1 showed higher LAdias and LA minimal volumes, while LA reservoir function was lower in Group 2. The LVdias/LAdias ratio was lower in Group 1 compared to Group 2 (TTE 1.77 ± 0.61 vs. 2.24 ± 1.24, p = 0.0025, CTCA 1.50 ± 0.23 vs. 1.69 ± 0.41, p = 0.0002). A composite score based on four combined TTE parameters, namely, LVED index/mean wall thickness ≤57, ratio of early diastolic mitral inflow to mitral annular tissue velocities (E/e') >8, LVdias/LAdias ≤1.62, and LA reservoir function ≤0.58, yielded the highest discriminatory power (area under the curve-AUC = 0.772) for distinguishing patients with hypertensive heart disease (HHD). Collectively, we refer to these parameters as the LEDA score, with each parameter scored as one point. For LEDA scores of 0, 1, 2, 3, 4, the probability of underlying HHD was 0%, 23%, 59%, 80%, and 95%, respectively. Furthermore, a CTCA-derived LVdias/LAdias ≤1.76, considered as a single parameter, demonstrated modest accuracy in differentiating patients with HHD (AUC = 0.646).
Conclusions:
The TTE LEDA score, based on four parameters, namely, LVED index/mean wall thickness, E/e', LVdias/LAdias, and LA reservoir function, proved to be the most effective in defining left heart remodelling in hypertension.
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