Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†

Abstract

Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.

Hypertension and alterations in left ventricular structure and geometry in African Americans: the Jackson Heart Study

“…This latter finding may be explained by the high prevalence of obesity in JHS, and that defining LVH using LVM indexed to body surface area may obscure an association between BMI and LVH. [7, 33] In the current study, higher BMI was associated with a higher odds of eccentric and concentric hypertrophy when LVH was defined using LVM indexed to height 2.7 . Although a prior study by Fox et al[19] demonstrated that impaired fasting blood glucose was associated with a higher prevalence of concentric remodeling (p=0.05) among 1,512 African American women in the JHS cohort, the current study did not find an association between diabetes and elevated hemoglobin A1c levels with any of the three abnormal LV structural patterns.…”

“…LVH was defined as LVMI ≥ 45 g/m 2.7 in females and ≥ 49 g/m 2.7 in males. [7, 30] A p-value <0.05 was considered to be statistically significant. Analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC).…”

“…[5] Based on categorization by LVM index (LVMI: increased LVMI or normal LVMI) and also geometry (increased RWT or normal RWT), individuals can also be categorized into having one of four LV structural patterns: normal pattern (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). [6, 7] Each of the three abnormal LV patterns is associated with an increased risk for cardiovascular disease (CVD) events. [8–11] Recently, a classification system has been proposed that further subdivides individuals with eccentric hypertrophy and concentric hypertrophy into four categories based on LV chamber size: eccentric non-dilated and dilated hypertrophy, and concentric non-dilated and dilated hypertrophy.…”

Multimodality Imaging for Left Ventricular Hypertrophy Severity Grading: A Methodological Review

“…LVH can be caused by an adaptation of the myocardium to increased pressure or volume load, genetic mutations or systemic conditions, as summarized in Table 1 3)4)5)6)7)8)9)10)11)12)13)14)15)16). LVH develops gradually, and therefore patients remain asymptomatic in early stages.…”

“…LVH develops gradually, and therefore patients remain asymptomatic in early stages. When the condition progresses, symptoms related to diastolic and systolic dysfunction ultimately bring the patient to the clinic 6). Analysing the grade of LVH severity is of great importance to clinical practice in terms of prognosis and treatment choices.…”