Limited echocardiography for hypertensive left ventricular hypertrophy.

Abstract

Echocardiographic assessment of left ventricular (LV) mass has provided the best noninvasive information to permit diagnostic, therapeutic, and prognostic assessment of hypertensive heart disease1 2 3 4 5 6 7 (Table 1⇓). Reversal of hypertension-induced LV hypertrophy (LVH) occurs with all pharmacological (and some nonpharmacological) antihypertensive treatment, although few data are yet available to demonstrate that such reversal is associated with a reduced risk of LVH. However, one recent report suggested that patients who had changes of reversal of LVH (by electrocardiography [ECG]) were at substantially reduced risk compared with those who did not demonstrate diminished LVH.9 However, the cost of echocardiography has limited its utility in patients with hypertension. A less time-consuming and less-expensive LVH screening echocardiogram would be of great value; such a procedure is referred to as a limited echocardiogram.10 View this table: Table 1. Summary of Epidemiological Studies Relating Echocardiographic Left Ventricular Mass With Long-term Prognosis Echocardiography has been used as a standard procedure for the calculation of LV muscle mass for more than 25 years.11 Primary measurements of LV dimensions are made according to American Society of Echocardiography standards using the leading edge method of interface recognition and by identifying end diastole and end systole at the QRS onset and nadir of posterior systolic motion of the interventricular septum.12 13 14 Adequate M-mode images for calculation of LV mass can be obtained in approximately 90% of patients in an experienced echo laboratory.15 16 17 Assessment of the degree of LVH should include measurements of the posterior wall and septal thickness and calculation of LV mass index. However, even in patients with good-quality studies, there is significant intrareader and interreader variability of LV mass.15 For instance, in the Treatment of Mild Hypertension Study, the variance between the two readers was 23.8% (49.2g), and …