Essentials of Hypertension by Flávio Danni Fuchs

Author:Flávio Danni Fuchs
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

3.6.2 Echocardiography

There is extensive literature showing cardiac structural and functional echocardiographic abnormalities in patients with hypertension and prehypertension. Among the structural consequences, LVH is noticeable, including mostly but not only concentric remodeling [61]. Nondilated and dilated concentric hypertrophies and dilated eccentric hypertrophies are associated with a higher risk of cardiovascular events, but nondilated eccentric hypertrophy is not [62, 63].

The main consequence of LVH is impairment of left ventricular diastolic function . Echocardiography is the preferred method for clinical assessment of diastolic function . The old-fashioned method to evaluate diastolic function—the E/A wave ratio—has been progressively replaced by Doppler tissue imaging. The ratio between the standard mitral inflow maximal velocity (E) and the mitral annular relaxation velocity (E′)—E/E′—is currently the standard for evaluation of diastolic function. Diastolic function deteriorates with aging but is strongly influenced by BP. This evolution is the natural history of hypertensive cardiomyopathy (as described in Chap. 1), leading to development of heart failure with a preserved ejection fraction .

In a community-based cohort study, individuals older than 45 years, free of heart failure, were examined by echocardiography 4 years apart and were further followed for 6 years [64]. The incidence of heart failure was higher in participants who had persistent, or progression to, moderate to severe diastolic dysfunction and in those who had persistent, or progression to, mild diastolic dysfunction, in comparison with participants who retained normal, or who normalized, diastolic function (Fig. 3.10).

Fig. 3.10Diastolic function in two evaluations and incidence of heart failure during follow-up for 6 years [64]

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