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Echocardiography in Hypertension: a Call for Standardization from the Working Group on Heart and Hypertension of the Italian Society of Hypertension

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Abstract

The variety of clinical information provided by the echocardiogram (i.e. assessment of left ventricular (LV) structure and geometry, systolic/diastolic function, left atrial and aortic size) in addition to its superior sensitivity for LV hypertrophy detection compared to electrocardiogram are strong arguments supporting the paramount importance of this technique in the assessment of hypertensive heart disease. A number of limitations of the echocardiographic technique, however, including lack of standardized/quantitative procedures, impair its diagnostic accuracy and cost-effectiveness. The aim of these recommendations is to provide a document on the minimum acceptable requirements for the clinical practice of echocardiography in the hypertensive setting and thus to improve the quality of this fundamental tool in the cardiovascular risk stratification of hypertensive patients.

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References

  1. Gottdiener JS. Hypertension: left ventricular hypertrophy, hypertensive heart disease, and the impact of echocardiographic data on treatment options, prognosis and assessment of therapy. In: Otto CM, editor. The practice of clinical echocardiography. Philadelphia: Saunders Company; 1997. p. 521–546.

  2. Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001;141:334–41.

    Article  CAS  PubMed  Google Scholar 

  3. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550–8.

    Article  CAS  PubMed  Google Scholar 

  4. Khouri MG, Peshock RM, Ayers CR, de Lemos JA, Drazner MH. A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study. Circ Cardiovasc Imaging. 2010;3:164–71.

    Article  PubMed  Google Scholar 

  5. Ruilope LM, Schmieder RE. Left ventricular hypertrophy and clinical outcomes in hypertensive patients. Am J Hypertens. 2008;21:500–6.

    Article  PubMed  Google Scholar 

  6. Cuspidi C, Rescaldani M, Sala C. Prevalence of echocardiographic left atrial enlargement in hypertension: a systematic review of recent clinical studies. Am J Hypertens. 2013;26:456–64.

    Google Scholar 

  7. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003;289:2560–72.

    Google Scholar 

  8. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27:2121–56.

    Article  CAS  PubMed  Google Scholar 

  9. Agabiti-Rosei E, de Simone G, Mureddu GF, Trimarco B, Verdecchia P, Volpe M. Arterial hypertension and cardiac damage: diagnostic and therapeutic guidelines. High Blood Press Cardiovasc Prev. 2008;15:141–69.

    Article  Google Scholar 

  10. Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monagham M, et al. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008;9:438–48.

    Article  PubMed  Google Scholar 

  11. Poppe KK, Doughty RN, Whalley GA. Redefining normal reference rages for echocardiography: a major new individual person data meta-analysis. Eur Heart J Cardiovasc Imaging. 2013;14:347–8.

    Article  PubMed  Google Scholar 

  12. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991;114:345–52.

    Article  CAS  PubMed  Google Scholar 

  13. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–6.

    Article  CAS  PubMed  Google Scholar 

  14. Levy D, Salomon M, D’Agostino RB, Belanger AJ, Kannel WB. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation. 1994;90:1786–93.

    Article  CAS  PubMed  Google Scholar 

  15. Bombelli M, Facchetti R, Carugo S, Madotto M, Arenare F, Quarti-Trevano F, et al. Left ventricular hypertrophy increases cardiovascular risk independently of in- and out-of office blood pressure values. J Hypertens. 2009;27:2458–64.

    Article  CAS  PubMed  Google Scholar 

  16. Tsioufis C, Vezali E, Tsiachris D, Dimitriadis K, Taxiarchou E, Chatzis D, et al. Left ventricular hypertrophy versus chronic kidney disease as predictors of cardiovascular events in hypertension: a Greek 6-year-follow-up study. J Hypertens. 2009;27:744–52.

    Article  CAS  PubMed  Google Scholar 

  17. Barbieri A, Bursi F, Mantovani F, Valenti C, Quaglia M, Berti E, et al. Left ventricular hypertrophy reclassification and death: application of the Recommendation of the American Society of Echocardiography/European Association of Echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13:109–17.

    Article  PubMed  Google Scholar 

  18. Bouzas-Mosquera A, Broullon FJ, Alvarez-Garcia N, Peteiro J, Mosquera VX, Castro-Beiras A. Association of left ventricular mass with all-cause mortality, myocardial infarction and stroke. PLOS ONE. 2012;7:e45570.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. de Simone G, Izzo R, Chinali M, De MM, Casalnuovo G, Rozza F, Girfoglio D, Iovino GL, Trimarco B, De LN. Does information on systolic and diastolic function improve prediction of a cardiovascular event by left ventricular hypertrophy in arterial hypertension? Hypertension. 2010;56:99–104.

    Article  PubMed  Google Scholar 

  20. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.

    Article  CAS  PubMed  Google Scholar 

  21. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. American Society of Echocardiography’s Nomenclature and Standards Committee, Task Force on Chamber Quantification, American College of Cardiology Echocardiography Committee, American Heart Association, European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108.

    Google Scholar 

  22. de Simone G, Muiesan ML, Ganau A, Longhini C, Verdecchia P, Palmieri V, et al. Reliability and limitations of ecocardiographic measurement of left ventricular mass for risk stratification and follow-up in single patients: the RES trial. Working Group on Heart and Hypertension of the Italian Society of Hypertension. Reliability of M-mode Echocardiographic Studies. J Hypertens. 1999;17:1955–63.

    Article  PubMed  Google Scholar 

  23. Mor-Avi V, Sugeng L, Weinert L, MacEneaney P, Caiani EG, Koch R, Salgo IS, Lang RM. Fast measurement of left ventricular mass with real-time three-dimensional echocardiography: comparison with magnetic resonance imaging. Circulation. 2004;110:1814–8.

    Article  PubMed  Google Scholar 

  24. Schillaci G, Verdecchia P, Porcellati C, Cuccurullo O, Cosco C, Perticone F. Continuous relationship between left ventricular mass and cardiovascular risk in essential hypertension. Hypertension. 2000;35:580–6.

    Article  CAS  PubMed  Google Scholar 

  25. Cuspidi C, Facchetti R, Sala C, Bombelli M, Negri F, Carugo S, et al. Normal values of left ventricular mass: echocardiographic findings of the PAMELA study. J Hypertens. 2012;30:997–1003.

    Article  CAS  PubMed  Google Scholar 

  26. Wild PS, Sinning CR, Roth A, Wilde S, Schnabel RB, Lubos E, et al. Distribution and categorization of left ventricular measurements in the general population. Results from the population-based Gutenberg heart study. Circ Cardiovasc Imaging. 2010;3:604–13.

    Article  PubMed  Google Scholar 

  27. de Simone G, Kizer JR, Chinali M, Roman MJ, Bella JN, Best LG, For the Strong Heart Study Investigators, et al. Normalization for body size and population attributable risk of left ventricular hypertrophy. Am J Hypertens. 2005;18:191–6.

    Article  PubMed  Google Scholar 

  28. Cuspidi C, Negri F, Giudici V, Muiesan ML, Grandi AM, Ganau A, et al. on behalf of the Working Group on Heart and Hypertension of the Italian Society of Hypertension. Self-reporting weight and height implications for left ventricular hypertrophy detection: an Italian multicenter study. Clin Exp Hypertens. 2011;33:192–201.

    Article  PubMed  Google Scholar 

  29. Muiesan ML, Salvetti M, Monteduro C, Bonzi B, Paini A, Viola S, et al. Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients. Hypertension. 2004;43:731–8.

    Article  CAS  PubMed  Google Scholar 

  30. Palmieri V, Wachtell K, Gerdts E, Bella JN, Papademetriou V, Tuxen C, et al. Left ventricular function and hemodynamic features of inappropriate left ventricular hypertrophy in patients with systemic hypertension: the LIFE study. Am Heart J. 2001;141:784–91.

    Article  CAS  PubMed  Google Scholar 

  31. de Simone G, Palmieri V, Koren MJ, Mensah GA, Roman MJ, Devereux RB. Prognostic implications of the compensatory nature of left ventricular mass in arterial hypertension. J Hypertens. 2001;19:119–25.

    Article  PubMed  Google Scholar 

  32. Muiesan ML, Salvetti M, Paini A, Monteduro C, Galbassini G, Bonzi B, Poisa P, Belotti E, Agabiti Rosei C, Rizzoni D, Castellano M, Agabiti Rosei E. Inappropriate left ventricular mass changes during treatment adversely affects cardiovascular prognosis in hypertensive patients. Hypertension. 2007;49:1077–83.

    Article  CAS  PubMed  Google Scholar 

  33. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10:165–93.

    Article  PubMed  Google Scholar 

  34. Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. 1994;69:212–24.

    Article  CAS  PubMed  Google Scholar 

  35. Sharp AS, Tapp RJ, Thom SA, Francis DP, Hughes AD, Stanton AV, et al. Tissue Doppler E/E′ ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT sub-study. Eur Heart J. 2010;31:747–52.

    Article  PubMed  Google Scholar 

  36. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  CAS  PubMed  Google Scholar 

  37. Yeaboah J, Rodriguez CJ, Stacey B, Lima JA, Liu S, Carr JJ, et al. Prognosis of individuals with asymptomatic left ventricular systolic dysfunction in the multi-ethnic study of atherosclerosis (MESA). Circulation. 2012;126:2713–9.

    Article  Google Scholar 

  38. De Simone G, Devereux RB. Midwall mechanics in hypertension. Eur J Echocardiogr. 2002;3:193–8.

    Google Scholar 

  39. Aurigemma GP, Silver KH, Priest MA, Gaasch WH. Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy. J Am Coll Cardiol. 1995;26:195–202.

    Article  CAS  PubMed  Google Scholar 

  40. Mondillo S, Galderisi M, Ballo P, Marino PN. Left ventricular systolic longitudinal function: comparison among simple M-Mode, pulsed, and M-mode color tissue doppler of mitral annulus in healthy individuals. J Am Soc Echocardiogr. 2006;19:1085–91.

    Article  PubMed  Google Scholar 

  41. Narayanan A, Aurigemma GP, Chinali M, Hill JC, Meyer TE, Tighe DA. Cardiac mechanics in mild hypertensive heart disease: a speckle-strain imaging study. Circ Cardiovasc Imaging. 2009;2:382–90.

    Article  PubMed  Google Scholar 

  42. Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T. Early predictors of alterations in left atrial structure and function related to left ventricular dysfunction in asymptomatic patients with hypertension. J Am Soc Hypertens. 2013;7:206–15.

    Article  PubMed  Google Scholar 

  43. Lester SJ, Ryan EW, Schiller NB, Foster E. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol. 1999;84:829.

    Article  CAS  PubMed  Google Scholar 

  44. Tsang TS, Abhayaratna WP, Barnes ME, Miyasaka Y, Gersh BJ, Bailey KR, Cha SS, Seward JB. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol. 2006;47:1018–23.

    Article  PubMed  Google Scholar 

  45. Evangelista A, Flachskampf FA, Erbel R, Antonini-Canterin F, Vlachopoulos C, Rocchi G, European Association of Echocardiography, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr. 2010;11(8):645–58.

    Article  PubMed  Google Scholar 

  46. Baguet JP, Chavanon O, Sessa C, Thony F, Lantelme P, Barone-Rochette G, Mallion JM. European Society of Hypertension scientific newsletter: hypertension and aortic diseases. J Hypertens. 2012;30:440–3.

    Article  PubMed  Google Scholar 

  47. Devereux RB, de Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV, et al. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons ≥15 years of age. Am J Cardiol. 2012;110:1189–94.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Milan A, Avenatti E, Tosello F, Iannaccone A, Leone D, Magnino C, Veglio F. Aortic root dilatation in essential hypertension: prevalence according to new reference values. J Hypertens. 2013;31:1189–95.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Authors and Affiliations

  1. Department of Health Science, University of Milano-Bicocca, Istituto Auxologico Italiano, Milan, Italy

    Cesare Cuspidi

  2. Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy

    Maria Lorenza Muiesan, Massimo Salvetti & Enrico Agabiti-Rosei

  3. Dipartimento di Medicina Clinica e Scienze Cardiovascolari ed Immunologiche, Università Federico II, Naples, Italy

    Nicola De Luca

  4. Dipartimento di Medicina, Università degli Studi di Perugia e Unità di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy

    Giuseppe Schillaci

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  1. Cesare Cuspidi
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  2. Maria Lorenza Muiesan
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  3. Nicola De Luca
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  4. Massimo Salvetti
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  5. Enrico Agabiti-Rosei
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  6. Giuseppe Schillaci
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Correspondence to Cesare Cuspidi.

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On behalf of the Working Group on Heart and Hypertension of the Italian Society of Hypertension.

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Cuspidi, C., Muiesan, M.L., De Luca, N. et al. Echocardiography in Hypertension: a Call for Standardization from the Working Group on Heart and Hypertension of the Italian Society of Hypertension. High Blood Press Cardiovasc Prev 21, 53–61 (2014). https://doi.org/10.1007/s40292-013-0030-3

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