The impact of different echocardiographic diagnostic criteria on the prevalence of left ventricular hypertrophy in essential hypertension

Coca, António; Gabriel, Ruvin; Figuera, Mariano de la; López‐Sendón, José‐Luis; Fernández, Reinerio Trujillo; Sagastagoitia, José Domingo; Garcia, Jorge; Barajas, R.

doi:10.1097/00004872-199917100-00016

Cited by 70 publications

(49 citation statements)

References 30 publications

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“…Third, although in our series obesity was present in a lower percentage (19%) than in previous studies reporting a two/threefold higher prevalence of this phenotype, 13,23 we were able to show a large difference in LVH prevalence in the whole population as well as in the largest subgroup of overweight subjects by using the two indexation methods. The clinical relevance of this observation is that LVH should be identified by adjusting LVM to height not only in obese but also in overweight hypertensive individuals.…”

Section: Discussioncontrasting

confidence: 80%

“…22 In the VITAE Study (Ventriculo Izquierdo Tension Arterial Espana) including 946 essential hypertensives (53.3% women, 45% obese) from primary care centres, LVH prevalence ranged from 59.2% by indexing to BSA (that is, LVMI X111/102 g m À2 ) to 70.7% by indexing to height (that is, LVMI X50/ 47 g m À2.7 ). 23 In the Gubbio Population Study, a clinical survey performed in a small Italian town, the prevalence of LVH among 250 hypertensive patients was nearly twofold higher (43.6 vs 24.0%) when LVM was indexed to height (that is, LVMI 49.2/46.7 g m À2.7 ) compared to BSA indexation (that is, 116/104 g m À2 ). 24 Although these and other studies 13,25 have shown that indexation of LVM to height raised to its allometric power yields the highest prevalence of LVH, no data are provided about the classification of subjects according to BMI categories, as performed in the present report.…”

Section: Discussionmentioning

confidence: 99%

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Indexation of left ventricular mass to body surface area and height to allometric power of 2.7: is the difference limited to obese hypertensives?

et al. 2009

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Whether left ventricular mass (LVM) should be normalized to different indexes in relation to body size is still debated. We sought to evaluate the prevalence of left ventricular hypertrophy (LVH) defined by different indexation criteria in a cohort of hypertensive subjects categorized according to body mass index (BMI). A total of 2213 essential hypertensive subjects included in the Evaluation of Target Organ Damage in Hypertension (ETODH) were divided in three groups according to BMI thresholds (o25, 25-29.9 and X30 kg m À2 ). All patients underwent extensive investigations including quantitative echocardiography. LVH was defined as an LVM index equal to or higher than (1) 125 g m À2 in men and 110 g m À2 in women, (2) 51 g m À2.7 in men and 47 g m À2.7 in women. Overall, 687 out of 2213 patients (31.0%) were found to have LVH when LVM was indexed to body surface area (BSA) and 1030 (46.5%) when indexed to height 2.7 . A total of 845 patients (38.2%) had normal BMI, 954 patients (43.1%) were overweight and 414 (18.7%) were obese. Prevalence rates of LVH in the three groups were 25.1, 31.6, 41.2% by indexation to BSA and 29.9, 50.5, 71.8% by indexation to height 2.7 , respectively. LVM indexed to BSA markedly underestimates LVH prevalence in obese as well as overweight hypertensive patients. To avoid a systematic misclassification of cardiovascular risk, LVM should be routinely indexed to height 2.7 in overweight and obese patients representing a large percentage of the hypertensive population.

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Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Indexation of left ventricular mass to body surface area and height to allometric power of 2.7: is the difference limited to obese hypertensives?

et al. 2009

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“…29,30 Our values, however, are in line with that reported (70%) in a large Spanish survey of 946 essential hypertensives from primary care centres. 31 Several factors may explain the high prevalence of LVH in our survey: (1) old age (less than 7% of our patients were o40 years); (2) duration of hypertension (less than 20% were untreated, that is, in the initial phase); moreover, up to 50% of patients had a previous echo examination and was reassessed for LVH regression; (3) non-standardized identification of LV interfaces due to the lack of a reading centre. This latter methodological aspect could be in part responsible for large differences in LVH prevalence seen among the centres.…”

Section: Echocardiography In Hypertension C Cuspidi Et Almentioning

confidence: 99%

Echocardiography in clinical practice: the burden of arterial hypertension. A multicenter Italian survey

et al. 2009

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Little information is available about the burden of hypertension on echo-lab activity in current practice. The aim of the present nation-wide survey in outpatient echo-labs was to investigate the prevalence rates of (1) echo examinations performed for the evaluation of hypertensive cardiac damage; (2) reports providing quantitative data on left ventricular (LV) structure and geometry; (3) LV hypertrophy (LVH) in hypertensives referred to echo labs. The study was carried out in 14 outpatient echo-labs across Italy. Prescriptions written by general practitioners were used to identify the indications for the examinations. Estimates of LVH were derived from original echo reports or were calculated from LV primary measures, when available, with Devereux's formula in a post-analysis. Echo examination was performed in 2449 subjects (1245 men and 1204 women); hypertension was the indication for echo in 745 (30.4%) cases. In this subgroup, LV mass (LVM), LVM indexed to body surface area, LVM indexed to height 2.7 and relative wall thickness ratio were reported in 58, 59, 54 and 52%, respectively. LVH was present in 53% of untreated hypertensives and, among treated patients, in 45 and 65% of those with and without blood pressure control, respectively. Our findings show that (1) hypertension accounts for approximately one-third of echo examinations performed in clinical practice; (2) a large fraction of echo reports do not provide quantitative data on LVM and LV geometry, (3) LVH is highly prevalent in hypertensives referred to echo labs for assessment of cardiac damage.

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“…To date, only few surveys have assessed the impact of different echocardiographic diagnostic criteria on the prevalence of LVH in a representative populationbased sample of essential hypertensives. Coca et al 29 investigated 946 hypertensive patients seen in primary care centres, using three cut off values, and found that LVH mass was present in 58% to 72% of subjects.…”

Section: Echocardiography In Hypertensive Patients: When and How?mentioning

confidence: 99%

Influence of different echocardiographic criteria for detection of left ventricular hypertrophy on cardiovascular risk stratification in recently diagnosed essential hypertensives

et al. 2001

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Background: Hypertensive patients with left ventricular hypertrophy (LVH) need a prompter and more intensive pharmacological treatment than subjects without evidence of cardiac involvement. So the detection of LVH plays an important role for decision-making in hypertensives. Objective: To evaluate the impact of different echocardiographic criteria to define LVH in a more precise stratification of absolute cardiovascular risk in hypertensives without target organ damage (TOD) as assessed by routine investigations. Methods: A total of 100 never treated patients with grade 1 and 2 essential hypertension (53 men, 47 women, age 44 ؎ 12 years) referred for the first time to our outpatient clinic were included in the study. They underwent the following procedures: (1) family and personal medical history, (2) clinic blood pressure (BP) measurement, (3) routine blood chemistry and urine analysis, (4) electrocardiogram, (5) echocardiogram. Risk was stratified according to the criteria suggested by the 1999 WHO-ISH guidelines. TOD was initially evaluated by routine procedures only, and subsequently reassessed by using six different echocardiographic criteria to recognise LVH: (a) left ventricular mass index (LVMI)

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The impact of different echocardiographic diagnostic criteria on the prevalence of left ventricular hypertrophy in essential hypertension

Cited by 70 publications

References 30 publications

Indexation of left ventricular mass to body surface area and height to allometric power of 2.7: is the difference limited to obese hypertensives?

Indexation of left ventricular mass to body surface area and height to allometric power of 2.7: is the difference limited to obese hypertensives?

Echocardiography in clinical practice: the burden of arterial hypertension. A multicenter Italian survey

Influence of different echocardiographic criteria for detection of left ventricular hypertrophy on cardiovascular risk stratification in recently diagnosed essential hypertensives

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