Myocardial Abnormalities In Patients Research Articles

Assessment of N-terminal pro-brain natriuretic peptide in patients with arrhythmia due to undifferentiated connective tissue disease

Aim. To study the relationship between the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and myocardial abnormalities in patients with cardiac arrhythmias due to undifferentiated connective tissue disease (UCTD).Material and methods. This cross-sectional comparative study included young and middle-aged patients with arrhythmias due to UCTD: group 1 (18-44 years old, n=127), group 3 (45-59 years old, n=10). The control groups (n=30, group 2; n=8, group 4) included volunteers with single phenotypic signs of UCTD, comparable in age and sex. A standard clinical examination, 72-hour electrocardiographic monitoring, Speckletracking echocardiography, and NT-proBNP level assessment were performed.Results. In patients of groups 1 and 3, a significant increase in the concentration of NT-proBNP was noted compared to the control groups. At the same time, the average NT-proBNP level in the study groups did not exceed the reference values. Significant correlations were revealed between NT-proBNP and heart rate (r1=0,462, p=0,010; r3=0,397, p=0,034), UCTD diagnostic cut-off level (r1=0,496, p=0,001; r3=0,401, p=0,043), the presence of mitral valve prolapse (r1=0,469, p=0,002) and mitral regurgitation (r1=0,53, p=0,008), premature ventricular contractions (PVCs) of class III (r1=0,582, p=0,045), IVa (r1= 0,39, p=0,042) and V (r1=0,397, p=0,037); cardiac index (r1=-0,329, p=0,037) and ejection fraction (r1=-0,407, p=0,044). However, no significant correlation was found between the left ventricular global longitudinal strain and NT-proBNP level.Conclusion. The study demonstrated the association of NT-proBNP level with UCTD diagnostic cut-off level, mitral valve prolapse, mitral regurgitation, and PVCs, which makes possible the use of this biomarker as an additional diagnostic criterion for myocardial changes in against the background of UCTD.

State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review.

Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing “idiopathic” ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging.

Impaired myocardial work in paediatric patients with wolff-parkinson-white syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. Left ventricle (LV) dysfunction due to electrical dyssynchrony may require catheter ablation of the accessory pathway, even in asymptomatic patients. Purpose The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in patients with WPW. Methods Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in the study: 12 cases with manifest WPW and 32 age-, sex- and arterial pressure- matched controls (CTR). LV ejection fraction (EF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. Results Despite normal LV systolic function by standard echocardiographic parameters, patients with WPW had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs 1624.0 ± 305.8 mmHg% in CTR, p = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs 2069.0 ± 319.9 mmHg% in CTR, p= 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs 90.9 ± 58.9 mmHg% in CTR, p= 0.0008) and GWE (90.5 ± 4.8% in WPW vs 95.2 ± 2.2% in CTR, p= 0.00006). There were no significant differences in GLS and EF between patients with WPW and controls. Conclusion Myocardial work indices were found significantly reduced in patients with WPW, even in presence of normal LV EF and GLS. In patients with WPW, MWI may represent a sensitive measure of myocardial dysfunction and help in the decision-making for catheter ablation. Abstract Figure. Myocardial work in WPW Abstract Figure. Myocardial work in control patient

COVID-19 myocarditis cardiac magnetic resonance findings in symptomatic patients.

Coronavirus disease 2019 (COVID-19) may cause myocardial damage. To evaluate the short-term and medium-term results, as well as the imaging features of COVID-19 cardiac involvement, using cardiac magnetic resonance (CMR). In this study, laboratory and CMR findings of 15 patients with COVID-19 between May 2020 and May 2021 were evaluated retrospectively. Late gadolinium enhancement (LGE) imaging was evaluated for myocarditis. Cardiac functions were quantitatively evaluated and compared to the control patient group. High-sensitivity cardiac troponin I (Hs-cTnI), C-reactive protein (CRP) exchange, and LGE were compared. Fifteen patients (7 women; mean age = 38 years) were evaluated. Six patients were treated at home, while nine patients were treated in the hospital. The patients were given remdesivir and hydroxychloroquine treatment. LGE was detected in 2 (33%) patients treated at home and 5 (55.5%) patients treated in the hospital. In hospitalized patients, levels of Hs-cTnI (mean = 7.8 pg/mL) and CRP (mean = 32.3 mg/L) were elevated. A high correlation was observed between the increase in Hs-cTnI value and LGE (r = 0.63; P < 0.001). A low correlation was observed between an increase in CRP and LGE (r = 033; P < 0.001). There was no statistically significant difference in ventricular functions between the COVID-19 and control groups (P < 0.001). CMR abnormalities were found in a high percentage (46%) of patients with COVID-19. Myocardial abnormalities in patients with COVID-19 can be detected by CMR. For COVID-19 myocarditis, no specific diagnostic CMR imaging feature was observed.

MRI and CT coronary angiography in survivors of COVID-19

ObjectivesTo determine the contribution of comorbidities on the reported widespread myocardial abnormalities in patients with recent COVID-19.MethodsIn a prospective two-centre observational study, patients hospitalised with confirmed COVID-19 underwent gadolinium and...

Myocardial tissue characterization and strain analysis in healthy pregnant women using cardiovascular magnetic resonance native T1 mapping and feature tracking technique

BackgroundPeripartum cardiomyopathy is a life-threatening condition that occurs during the peripartum period in previously healthy women. Cardiovascular magnetic resonance (CMR) T1 mapping permits sensitive detection of tissue edema and fibrosis, and it may be useful in identifying altered myocardial tissue characteristics in peripartum cardiomyopathy. However, left ventricular (LV) volumes and mass increase considerably even in normal pregnancy, and it is not known whether altered tissue characteristics can be found in normal pregnancy. The aim of this study was to investigate whether the LV remodeling observed in normal pregnancy is associated with altered tissue characteristics determined by CMR.MethodsTwelve normal pregnant women and 15 non pregnant women underwent cine CMR and myocardial T1 measurement at 1.5 T. Pregnant women were scanned three times, in the 2nd and 3rd trimesters of pregnancy and at 1 month postpartum. LV volumes, LV mass (LVM), and global longitudinal strain (GLS) were analyzed by cine CMR. Native myocardial T1 was determined using modified Look-Locker inversion recovery (MOLLI) images.ResultsLV end-diastolic volume (EDV) was significantly greater in the 3rd trimester (126 ± 22 mL) than in non-pregnant women (108 ± 14 mL, p < 0.05). LVM was significantly greater in the 3rd trimester (88.7 ± 11.8 g) than at 1 month postpartum (70.0 ± 9.8 g, p < 0.05) and in non-pregnant women (66.3 ± 13.9 g, p < 0.05). Myocardial native T1 among the 2nd and 3rd trimesters, 1 month postpartum, and non-pregnant women were similar (1133 ± 55 ms, 1138 ± 86 ms, 1105 ± 45 ms, and 1129 ± 52 ms, respectively, p = 0.59) as were GLS (− 19.5 ± 1.8, − 19.7% ± 2.2, − 19.0% ± 2.0%, and − 19.3% ± 1.9%, respectively, p = 0.66).ConclusionsLV remodeling during normal pregnancy is associated with myocardial hypertrophy, but not with edema or diffuse fibrosis of the myocardium or LV contractile dysfunction. These results observed in normal pregnancy will serve as an important basis for identifying myocardial abnormalities in patients with peripartum cardiomyopathy and other pregnancy-related myocardial diseases.

P5506Relationship between electrical and myocardial abnormalities in patients with myotonic dystrophy type 1

P5506Relationship between electrical and myocardial abnormalities in patients with myotonic dystrophy type 1

MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF THE HEART LESIONS IN PATIENTS WITH ACROMEGALY

Актуальность. Акромегалия – заболевание, в основе которого лежит патологическая гиперсекреция соматотропного гормона и инсулиноподобных факторов роста. У пациентов с акромегалией независимо от других заболеваний сердечно-сосудистой системы формируется акромегалийная кардиомиопатия, которая, по данным мировой литературы, характеризуется проявлениями триады признаков: гипертрофия, отек и фиброз миокарда. Фиброз миокарда (диффузный интерстициальный) развивается по мере персистирования избытка соматотропного гормона и постепенного нарушения архитектоники сердечной мышцы. Однозначно высказаться о частоте кардиофиброза при акромегалийной кардиомиопатии затруднительно, что объясняется одиночными исследованиями в этой области с участием небольшого количества пациентов.

Detecting Regional Myocardial Abnormalities in Patients With Wolff-Parkinson-White Syndrome With the Use of ECG-Gated Cardiac MDCT.

Myocardial dyskinesia caused by the accessory pathway and related reversible heart failure have been well documented in echocardiographic studies of pediatric patients with Wolff-Parkinson-White (WPW) syndrome. However, the long-term effects of dyskinesia on the myocardium of adult patients have not been studied in depth. The goal of the present study was to evaluate regional myocardial abnormalities on cardiac CT examinations of adult patients with WPW syndrome. Of 74 patients with WPW syndrome who underwent cardiac CT from January 2006 through December 2013, 58 patients (mean [± SD] age, 52.2 ± 12.7 years), 36 (62.1%) of whom were men, were included in the study after the presence of combined cardiac disease was excluded. Two observers blindly evaluated myocardial thickness and attenuation on cardiac CT scans. On the basis of CT findings, patients were classified as having either normal or abnormal findings. We compared the two groups for other clinical findings, including observations from ECG, echocardiography, and electrophysiologic study. Of the 58 patients studied, 16 patients (27.6%) were found to have myocardial abnormalities (i.e., abnormal wall thinning with or without low attenuation). All abnormal findings corresponded with the location of the accessory pathway. Patients with abnormal findings had statistically significantly decreased left ventricular function, compared with patients with normal findings (p < 0.001). The frequency of regional wall motion abnormality was statistically significantly higher in patients with abnormal findings (p = 0.043). However, echocardiography documented structurally normal hearts in all patients. A relatively high frequency (27.6%) of regional myocardial abnormalities was observed on the cardiac CT examinations of adult patients with WPW syndrome. These abnormal findings might reflect the long-term effects of dyskinesia, suggesting irreversible myocardial injury that ultimately causes left ventricular dysfunction.

Structural and functional myocardial abnormalities in patients with Parkinson's disease compared with control group: an echocardiographic study

Structural and functional myocardial abnormalities in patients with Parkinson's disease compared with control group: an echocardiographic study

ASSESSMENT OF REGIONAL MYOCARDIAL STRAIN USING TWO DIMENSIONAL SPECKLE TRACKING TRANSTHORACIC ECHOCARDIOGRAPHY TO DISTINGUISH CARDIAC FOCAL FIBROTIC AND NON-FIBROTIC LESIONS CONFIRMED ON CARDIAC MAGNETIC RESONANCE IN HCM

Myocardial fibrosis (MF) in left ventricular myocardium (LVM) has been reported to be one of the major structural myocardial abnormalities in patients with hypertrophic cardiomyopathy (HCM). Detection of MF may be useful for risk stratification of such patients. To detect focal MF, we compared

Correlation between arterial wall stiffness, N-terminal prohormone of brain natriuretic peptide, functional and structural myocardial abnormalities in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy

Aim. To assess arterial wall stiffness, plasma levels of of N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as well as functional state and structure of the myocardium in patients with type 2 diabetes mellitus (T2DM) and cardiac autonomic neuropathy (CAN). Materials and Methods. The study involved a total of 65 patients with T2DM. 12 had no evidence of cardiovascular disease (CVD) or CAN, 14 were diagnosed with subclinical stage of CAN, 18 ? with functional stage, and 21 ? with organic stage. We measured aortic pulse wave velocity (PWV), aortic augmentation index (AIx), brachial artery AIx, ambulatory arterial stiffness index (AASI) and plasma levels of NT-proBNP. Clinical examination included ECG, Holter monitoring, ambulatory BP measurement and echocardiography. Results. Patients with isolated T2DM showed a trend for increased vascular wall stiffness. PWV was increased in patients with subclinical stage of CAN. Aortic and brachial AIx, PWV and AASI were elevated in patients with functional stage of CAN, PWV being significantly higher vs. subclinical CAN subgroup. Organic stage was characterized by pathologically increased values of all primary parameters; PWV and AASI were significantly higher compared with other groups. Development and progression of CAN was accompanied by an increase in NT-proBNP plasma levels. Concentration of NT-proBNP was in direct correlation with left ventricular mass (LVM) and PWV. PWV and LVM values also directly correlated between themselves. Conclusion. Development and progression of CAN in patients with T2DM is accompanied by an increase in vascular wall stiffness. The elevation of plasma NT-proBNP in patients with T2DM correlates with the development of CAN and is significantly and independently associated with an increase in LVM and PWV. Our data suggests the pathophysiological interconnection between metabolic, functional and structural myocardial abnormalities in patients with T2DM and CAN.

Regional Peak Longitudinal-Strain by 2D Speckle-Tracking TTE Provides Useful Information to Distinguish Fibrotic from Non-Fibrotic Lesions in LV Myocardium on Cardiac MR in Hypertrophic Cardiomyopathy

Fibrosis, myocardial hypertrophy, fiber disarray, and loose connective tissue in the left ventricular (LV) myocardium (LVM) have been reported to be major structural myocardial abnormalities in patients with hypertrophic cardiomyopathy (HCM) [1].

FRI0246 Detection of left ventricular regional dysfunction and myocardial abnormalities using complementary cardiac magnetic resonance imaging in patients with systemic sclerosis without cardiac symptoms

BackgroundIn patients with systemic sclerosis (SSc), myocardial involvement is common, may have serious consequences, and may lead to a poor prognosis. Regional left ventricular (LV) dysfunction reflects myocardial involvement. The...

Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries

A variety of conditions other than acute myocardial infarction may cause ST-elevation. Our objective was to evaluate the impact of cardiac magnetic resonance (CMR) on differential diagnosis from a prospective series of patients with suspected ST-elevation myocardial infarction (STEMI) and completely normal coronary arteries. Among 1,145 patients with suspected STEMI, 49 patients had completely normal coronary arteries and entered a prospective registry. CMR was done within 24 h, if possible, and included function analyses, T2-weighted imaging (T2 ratio), T1-weighted imaging before and after gadolineum administration (global relative enhancement; gRE), and late gadolineum enhancement (LGE). All patients were asked for a follow-up CMR after approximately 3 months. The incidence of patients with suspected STEMI and normal coronary arteries was 4.3% and mean age was 45 ± 14 years (STEMI group 64 ± 13 years; P < 0.001). 55% had a recent history of infection. Cardiac biomarkers showed a moderate elevation on admission. There was a significant change from baseline to follow-up for LV end-diastolic volumes (EDV) (P < 0.001), LV mass (P < 0.05), mean T2 ratio (P < 0.05), and LGE volume (P < 0.05). Major diagnostic groups were myocarditis (29%), pericarditis (27%), and takotsubo cardiomyopathy (10%). 18% were regarded as non-diagnostic. The study showed an incidence of 4.3% of patients with suspected STEMI and completely normal coronary arteries. Early CMR was valuable in the evaluation of the differential diagnoses and to exclude myocardial abnormalities in patients with uncertain aetiology. Further studies are needed for the assessment of long-term outcome.

Pre-Clinical Myocardial Metabolic Alterations in Chronic Kidney Disease

The risk for cardiovascular events conferred by decreased renal function is curvilinear with exponentially greater increases in risk as estimated glomerular filtration rate (eGFR) declines. In 13 non-diabetic pre-dialysis chronic kidney disease (CKD) patients, we employed quantitative F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) as a means to measure myocardial metabolic changes. Methods: Dynamic cardiac FDG PET images were acquired after 6 h fasting and glucose loading. Corrections for attenuation, scatter, randoms, dead time and decay were applied to the PET data and myocardial glucose utilization (MGU) was calculated using the Patlak method in conjunction with standardized myocardial regions of interest and an image-derived input function (left atrium). MGU was compared with eGFR based on a serum creatinine drawn within 2 weeks of the study date. Results: MGU was relatively uniform between the myocardial sectors (coefficient of variation = 16.2 ± 6.8%) within each patient. Between patients, whole myocardium MGU varied considerably with a range of 37.3–156.2 µmol/min/100 g and a mean of 68.9 ± 38.3 µmol/min/ 100 g. eGFR ranged from 11–89 ml/min/1.73 m² with a mean of 42.8 ± 26.9 ml/min/1.73 m². There was an inverse correlation between whole myocardium MGU and eGFR (Spearman’s rho correlation = –0.615, p = 0.025). In multivariate analysis, the relationship between MGU and eGFR was sustained with adjustment for age, race and gender (adjusted β = –1.56 ± 0.48, p = 0.01). There was no correlation between cardiac workload and eGFR (p = NS). Conclusions: A significant inverse correlation between MGU and eGFR is supportive of the hypothesis that CKD is associated with myocardial metabolic changes, which could not be attributed to demographic factors or cardiac workload. Dynamic FDG PET could provide a sensitive, non-invasive, quantitative tool for investigating pre-clinical myocardial abnormalities in patients with CKD.

Early Detection of Subclinical Anthracycline Cardiotoxicity on the Basis of QT Dispersion

We examined whether dobutamine-stress QT dispersion (QTd) and heart-rate corrected QT dispersion (QTcd) are useful for detecting subclinical anthracycline cardiotoxicity. The subjects were 10 control subjects and 37 patients divided into 4 groups according to cumulative anthracycline dose: non-anthracycline group (group N), 7 patients; low anthracycline cumulative dose group (group L), 8 patients (< 200 mg/m²); medium anthracycline cumulative dose group (group M), 16 patients (200 to < 400 mg/m²); and high cumulative group (group H), 6 patients (≥ 400 mg/m²). Standard 12-lead electrocardiograms were recorded. QTd and QTcd were measured and calculated at rest and after administration of dobutamine at 5 or 30 µg/kg/min. We also estimated cardiac function and cardiac reserve function at rest and after administration of dobutamine at a dose of 5 or 30 µg/kg/min. At rest, QTd and QTcd were significantly greater in groups M and H. After administration of dobutamine at 30 µg/kg/min, QTd and QTcd were significantly greater in groups L, M, and H. There was good correlation between QTd and the cumulative anthracycline dose; the correlation formula was y=0.051 x + 42.2 (r = 0.81, p < 0.001). The cumulative anthracycline dose of 152.9 mg/m², calculated from the correlation formula, was the cut-off for detection of electrophysiological cardiac abnormalities. Cardiac performance data at rest and dobutamine stress by echocardiography and pulsed Doppler echocardiography are less sensitive for detecting cardiac abnormalities than are QTd and QTcd. Dobutamine-stress QTd and QTcd are useful for detecting anthracycline cardiotoxicity and subclinical cardiac abnormality at low cumulative anthracycline doses. We must be aware of the possibility of subclinical myocardial abnormalities in patients with a cumulative anthracycline dose of ≥ 150 mg/m².

A Contemporary Approach to Hypertrophic Cardiomyopathy

A previously healthy 32-year-old female undergoes evaluation after a syncopal episode. Physical examination reveals a systolic ejection murmur. Echocardiography demonstrates a vigorous LV with marked asymmetric septal hypertrophy, systolic anterior motion of the mitral valve, and a 50–mm Hg outflow tract gradient. Family history is notable for unexpected death in 4 paternal family members. She has 2 children (Figure 1A). Figure 1. A, HCM is a genetic cardiovascular disease. This family shows autosomal dominant inheritance with &50% of the family affected and equal numbers of affected male (▪) and female (•) family members. The case patient is indicated by an arrow. Deceased individuals are indicated by a diagonal slash (all died suddenly). B, DNA sequence analysis can identify sarcomere mutations that cause HCM. Top, The normal sequence of a portion of the cardiac troponin T gene is displayed with a triplet codon, TCC, encoding serine present. Bottom, DNA sequence obtained from a patient with HCM. The normal sequence is present on the allele inherited from the unaffected parent; the other allele shows a single base-pair substitution of a thymidine residue for the normal cytosine residue. This triplet codon, TTC, encodes phenylalanine and results in the substitution of a phenylalanine residue for the normal serine residue at amino acid position 179. The prevalence of unexplained left ventricular hypertrophy (LVH) in the general population is estimated to be 1 in 500.1,2 Hypertrophic cardiomyopathy (HCM) caused by sarcomere mutations may account for up to 60% of unexplained LVH, making HCM the most common genetic cardiovascular disorder.3–5 Accurate diagnosis of HCM is important for appropriate management of major HCM comorbidities, including atrial fibrillation, stroke, heart failure, and sudden cardiac death (SCD).6,7 HCM typically is diagnosed by unexplained LVH on echocardiography. Age of onset of LVH ranges from early childhood to …

Effect of catheter device closure of atrial septal defect on diastolic mitral annular motion

Atrial septal defect closure with the Amplatzer septal occluder has a negative effect on diastolic mitral annulus motion in terms of decreasing longitudinal septal annular motion and changing the relation between the annulus motion and mitral inflow.

Myocardial abnormalities in hypertensive patients with normal and abnormal left ventricular filling: a study of ultrasound tissue characterization and strain.

Abnormal left ventricular (LV) filling is common, but not universal, in hypertensive LV hypertrophy (LVH). We sought to elucidate the relative contributions of myocardial structural changes, loading and hypertrophy to LV dysfunction in 113 patients: 85 with hypertensive LVH and 28 controls without LVH and with normal filling. Patients with normal dobutamine stress echocardiography and no history of coronary artery disease were selected, in order to exclude a contribution from ischaemia or scar. Abnormal LV filling was identified in 65 LVH patients, based on Doppler measurement of transmitral filling and annular velocities. All patients underwent grey-scale and colour tissue Doppler imaging from three apical views, which were stored and analysed off line. Integrated backscatter (IB) and strain rate imaging were used to detect changes in structure and function; average cyclic variation of IB, strain rate and peak systolic strain were calculated by averaging each segment. Calibrated IB intensity, corrected for pericardial IB intensity, was measured in the septum and posterior wall from the parasternal long-axis view. Patients with LVH differed significantly from controls with respect to all backscatter and strain parameters, irrespective of the presence or absence of abnormal LV filling. LVH patients with and without abnormal LV filling differed with regard to age, LV mass and incidence of diabetes mellitus, but also showed significant differences in cyclic variation (P<0.01), calibrated IB in the posterior wall (P<0.05) and strain rate (P<0.01), although blood pressure, heart rate and LV systolic function were similar. Multivariate logistic regression analysis demonstrated that age, LV mass index and calibrated IB in the posterior wall were independent determinants of abnormal LV filling in patients with LVH. Thus structural and functional abnormalities can be detected in hypertensive patients with LVH with and without abnormal LV filling. In addition to age and LVH, structural (not functional) abnormalities are likely to contribute to abnormal LV filling, and may be an early sign of LV damage. IB is useful for the detection of myocardial abnormalities in patients with hypertensive LVH.