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Echocardiography in hypertensive cardiomyopathy

hypertensive cardiomyopathyHypertensive cardiomyopathy defines all structural, morphological and functional cardiac effects caused by direct/indirect chronic high blood pressure. Are included: left ventricular hypertrophy, coronary artery disease, cardiac arrhythmias (atrial fibrillation, ventricular extrasystoles, ventricular tachycardia) and heart failure.

Transthoracic echocardiography is a noninvasive method that can be performed with new portable systems at bedside and highlights different features of hypertensive heart disease.

1. Left ventricular hypertrophy (LVH) – occurs in 15-20% of hypertensive patients. Echocardiography is more sensitive and specific than ECG in the diagnosis of left ventricular hypertrophy, with a role in cardiovascular risk stratification and therapeutic options. The assessment includes measuring the thickness of the interventricular septum and posterior wall, of the left ventricle (LV) diastolic and systolic diameter, measurement of left ventricular mass and mass index. (> 125 g/m2 in men and> 110g/m2 in women, equivalent to left ventricular hypertrophy).

Left ventricular hypertrophy ultrasound2. Left ventricle systolic function – ejection fraction, shortening fraction, end-diastolic and end-systolic volume of left ventricle, wave S ‘ at tissue Doppler;

3. Ventricular diastolic function – wave E, A, E/A, E-wave deceleration time, isovolumetric relaxation time, wave E ‘, wave A’, E/E ‘ at tissue Doppler.

4. Dimensions of aorta and left atrium;

5. Kinetics of the left ventricle at rest and stress;

6. Diagnosis of possible associated valvulopathy: Aortic sclerosis, aortic or mitral regurgitation.

In conclusion, the guide ACC/AHA/(2008) for the use of echocardiography in the evaluation of clinical syndromes indicate its performance in hypertensive patients:

  • when evaluating function of left ventricle, hypertrophy and concentric remodeling are important in therapeutic decision;
  • detection and evaluation of the functional significance of concomitant ischemic heart disease by echocardiography stress;
  • while following the size and LV function in hypertensive patients with LV dysfunction when there are documented changes in clinical status or to guide medical treatment;
  • identification of diastolic dysfunction in the presence / absence of systolic dysfunction;
  • Left ventricular hypertrophy assessment in patients with “borderline” hypertension  without electric left ventricular hypertrophy for the decision to initiate antihypertensive treatment.

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