Doppler echocardiography is a fundamental instrument to understand heart damage during essential arterial hypertension. Left ventricular (LV) hypertrophy may also be conveniently studied in its morphological and functional aspects by ultrasound application. Echocardiography can also provide important morphological and functional information in hypertensive patients for therapeutic management and prognostic stratification. In recent years, echocardiography has been enriched by very refined techniques that are capable of studying the physiopathological intramyocardial phenomena: (i) tissue Doppler (which studies intramyocardial velocities and time intervals and allows the analysis of strain and strain rate); (ii) integrated backscatter (which analyzes variations of myocardial reflectivity in decibels); (iii) transthoracic Doppler derived coronary flow reserve (which quantifies the vasodilator response of coronary velocities to a hyperaemic stimulation); (iv) myocardial echo-contrast- echocardiography (which studies the kinetics of ultrasound contrast microbubbles at the intramyocardial level); and (v) real-time three-dimensional (3-D) echocardiography [which allows a more precise evaluation of left ventricular (LV) volumes and LV mass]. These new methodological approaches have recently been used in the hypertensive Introduction Conventional echocardiography represents an accurate method for the clinical evaluation of hypertensive heart disease. Analysis of left ventricular (LV) mass (LVM) and volumes, and the study of LV systolic function (ejection fraction, midwall fractional shortening) and diastolic function (transmitral flow velocity and pulmonary vein flow), permits the correct stratification of hypertensive heart disease by a diagnostic and prognostic point of view. On the other hand, new ultrasonic technologies are emerging in the laboratory, which promise to be more sensitive and accurate than conventional echocardiogra- phy. The main application of these new techniques is in the early diagnosis of myocardial functional or morphological alterations, which are not detectable by conventional techniques. clinical setting to provide a deeper knowledge of the complex physiopathological and histopathological mechanisms underlying the modifications induced by arterial hypertension at the myocardial tissue level (myocytes, collagen, microcirculation). This review shows the advancement of high-tech ultrasound applied to hypertensive heart disease, pointing out limitations and incremental potentialities in comparison with conventional echocardiography.
New echocardiographic technologies in the clinical management of hypertensive heart disease
MONTISCI, ROBERTA;
2007-01-01
Abstract
Doppler echocardiography is a fundamental instrument to understand heart damage during essential arterial hypertension. Left ventricular (LV) hypertrophy may also be conveniently studied in its morphological and functional aspects by ultrasound application. Echocardiography can also provide important morphological and functional information in hypertensive patients for therapeutic management and prognostic stratification. In recent years, echocardiography has been enriched by very refined techniques that are capable of studying the physiopathological intramyocardial phenomena: (i) tissue Doppler (which studies intramyocardial velocities and time intervals and allows the analysis of strain and strain rate); (ii) integrated backscatter (which analyzes variations of myocardial reflectivity in decibels); (iii) transthoracic Doppler derived coronary flow reserve (which quantifies the vasodilator response of coronary velocities to a hyperaemic stimulation); (iv) myocardial echo-contrast- echocardiography (which studies the kinetics of ultrasound contrast microbubbles at the intramyocardial level); and (v) real-time three-dimensional (3-D) echocardiography [which allows a more precise evaluation of left ventricular (LV) volumes and LV mass]. These new methodological approaches have recently been used in the hypertensive Introduction Conventional echocardiography represents an accurate method for the clinical evaluation of hypertensive heart disease. Analysis of left ventricular (LV) mass (LVM) and volumes, and the study of LV systolic function (ejection fraction, midwall fractional shortening) and diastolic function (transmitral flow velocity and pulmonary vein flow), permits the correct stratification of hypertensive heart disease by a diagnostic and prognostic point of view. On the other hand, new ultrasonic technologies are emerging in the laboratory, which promise to be more sensitive and accurate than conventional echocardiogra- phy. The main application of these new techniques is in the early diagnosis of myocardial functional or morphological alterations, which are not detectable by conventional techniques. clinical setting to provide a deeper knowledge of the complex physiopathological and histopathological mechanisms underlying the modifications induced by arterial hypertension at the myocardial tissue level (myocytes, collagen, microcirculation). This review shows the advancement of high-tech ultrasound applied to hypertensive heart disease, pointing out limitations and incremental potentialities in comparison with conventional echocardiography.
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