DOI: http://dx.doi.org/10.18203/2349-3933.ijam20212400

Echocardiographic assessment of left ventricular mass index and function in hypertensive patients with preserved ejection fraction

Sabapathy K.

Abstract


Background: The aim of the present study is to detect left ventricular (LV) mass and to find out sub clinical LV diastolic dysfunction in hypertensive patients with preserved LV ejection fraction (EF) using echocardiographic parameters.

Methods: 96 patients with hypertension were randomly selected irrespective of their sex, race and risk factor and enrolled into this study. Left ventricular mass index (LVMI) and geometrical pattern LV structure were measured. Sub clinical diastolic dysfunction was also assessed by tissue Doppler.

Results: Out of 96 patients, 24 had ECG evidence of LV hypertrophy (LVH) 66 were having increased LVMI (154±20), rest 30 had normal LVMI (108±12). They were divided by LV geometrical pattern into concentric LVH (40), eccentric LVH (26), concentric remodeling (19) and normal (11). Diastolic dysfunction in these patients were assessed by E/E´ measurement which was abnormally increased in 42 out of 66 patients with increased LVMI (20±3.4) and 16 out of 30 patients with normal LVMI.

Conclusions: Echocardiographic examination help us to find out LVH precisely by calculating LVMI. It also reveals structural changes like concentric LVH, eccentric LVH, concentric remodeling. A significant number of patients with hypertension with normal LV ejection fraction has sub clinical LV diastolic dysfunction which was detected by tissue Doppler imaging (E/E′). The increase in LVMI with or without concentric LVH is an independent risk factor and prognostic marker for cardio vascular events that occur in hypertensive patients. In this study we infer that patients with increase in LVMI with concentric LVH pattern with normal ejection fraction needs more aggressive treatment and regular follow up to prevent cardiovascular complications.


Keywords


Echocardiography, LVH, LVMI, TDI, Hypertension

Full Text:

PDF

References


Verdecchia P, Carini G, Circo A, Dovellini E, Giovannini E, Lombardo M, et al. Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J Am Coll Cardiol. 2001;38:1829-35.

Schillaci G, Verdecchia P, Porcellati C, Cuccurullo O, Cosco C, Perticone F. Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension. Hypertension. 2000;35:580-6.

Krumholz HM, Larson M, Levy D. Prognosis of left ventricular geometricpatterns in the Framingham heart study. J Am Coll Cardiol. 1995;25:879-84.

Ghali JK, Liao Y, Cooper RS. Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol. 1998;31:1635-40.

Koulouris SN, Kostopoulos KG, Triantafyllou KA, Karabinos I, Bouki TP, KarvounisHI, et al. Impaired systolic dysfunction of left ventricular longitudinal fibers a sign of early hypertensive cardiomyopathy. Clin Cardiol. 2005;28:282-6.

Bountioukos M, Schinkel AF, Bax JJ, Lampropoulos S, Poldermans D. The impact of hypertension on systolic and diastolic left ventricular function. A tissue doppler echocardiographic study. Am Heart J. 2006;151:1327.

Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assessment of mitral annulus velocity by doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997;30:474-80.

Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788-94.

de Hartog-Keyzer JML, El Messaoudi S, Harskamp R, et alJElectrocardiography for the detection of left ventricular hypertrophy in an elderly population with long-standing hypertension in primary care: a secondary analysis of the CHELLO cohort study. BMJ Open. 2020;10:e038824.

Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study. N Engl J Med. 1990;322:1561-6.

Mensah GA, Pappas TW, Koren MJ, Ulin RJ, Laragh JH, Devereux RB. Comparison of classification of the severity of hypertension by blood pressure level and by World Health Organization criteria in the prediction of concurrent cardiac abnormalities and subsequent complications in essential hypertension. J Hypertens. 1993;11:1429-40.

Schillaci G, Verdecchia P, Porcellati C, Cuccurullo O, Cosco C, Perticone F. Continuous Relation Between Left Ventricular Mass and Cardiovascular Risk in Essential Hypertension. Hypertension. 2000;35:580-6.

Pewsner D, Juni P, Egger M, Battaglia M, Sundstrom J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: Systematic Rev. BMJ. 2007:335:711.

Sundstrom J, Lind L, Arnlov J, Zethelius B, Andren B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men. Circulation. 2001;103:2346 51.

Ganau, A, Devereux an, Roman Ml. Patterns of left ventricular hypertrophy and geometric remodelling in essential hypertension. J Am Coll Cardiol. 1992;19:1550-8.

Reichek N. Patterns of left ventricular response in essential hypertension. J Am Coil Cardiol. 1992;19:1559-60.

Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic; implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561-6.

Savage DD, Garrison RJ, Kannel WB. The spectrum of left ventricular hypertrophy in a general population sample: the Framingham Study. Circulation. 1987;75:1-26-33.

Aronow WS, Ahn C, Kronzon I, Koenigsberg M. Congestive heart failure, coronary events and atherothrombotic brain infarction in elderly blacks and whites with systemic hypertension and with and without echocardiographic and electrocardiographic evidence of left ventricular hypertrophy. Am J Cardiol 1991;67:295-9.

Krumholz HM, Larson M, Levy D. Prognosis of left ventricular geometric patterns in the Framingham Heart Study. J Am Coll Cardiol. 1995;25:879-84.

Ghali JK, Liao Y, Cooper RS. Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol. 1998;31:1635-40.

Devereux RB, Gerdts E, Wachtell K, et al. Regression of hypertensive left ventricular hypertrophy by losartan versus atenolol: the LIFE Study. Circulation. 2004;110:1456-62.

Triantafyllou KA, Karabinos E, Kalkandi H, Kranidis AI, Babalis D. Clinical implications of the echocardiographic assessment of left ventricular long axis function. Clin Res Cardiol. 2009;98:521-32.

Wang M, Yip GW, Wang AY, Zhang Y, Ho PY, Tse MK, et al. Tissue Doppler imaging provides incremental prognostic value in patients with systemic hypertension and left ventricular hypertrophy. J Hypertens. 2005;23:183-5.

Garcia M, Thomas J, Klein A. New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol. 1998;32:865-75.

Nagueh S, Sun H, Kopelen H. Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol. 2001;37:278-85.

Nishikage T, Nakai H, Lang RM, Takeuchi M. Subclinical left ventricular longitudinal systolic dysfunction in hypertension with no evidence of heart failure. Circ J. 2008;72:189-94.

Strand A, Kjeldsen SE, Gudmundsdottir H. Tissue Doppler imaging describes diastolic function in men prone to develop hypertension over twenty years. Eur J Echocardiogr. 2008;9:34-9.