Features of estimation of left ventricular geometry in patients with arterial hypertension

Authors

  • V. V. Syvolap Zaporizhzhia State Medical University, Ukraine,
  • Ye. V. Novikov Zaporizhzhia State Medical University, Ukraine,
  • V. A. Lysenko Zaporizhzhia State Medical University, Ukraine,
  • A. O. Bogun Zaporizhzhia State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1237.2017.3.118306

Keywords:

echocardiography, hypertension, left ventricular remodeling

Abstract

Aim: To compare the influence of the methods of calculating MMLV for Penn Convention and ASE on the distribution of left ventricular geometry types in patients with hypertension, to find out additional echographic criteria that will help to offset differences in the estimation of types of geometry.

Materials and methods: The study involved 100 patients with essential hypertension ІІ degree, ІІ stage, aged from 18 to 79 years (mean age 54.71 ± 13.93 years, 44% men). Echocardiography was performed on Esaote My Lab Seven (Italy) according to generally accepted rules. The distribution according to the types of left ventricular geometry was carried out in accordance with the recommendations for quantifying the structure and function of the left ventricle. Under normal index of MMLV, the main types of geometry were: normal geometry and concentric remodeling; in elevated – concentric and eccentric LVH. Additionally, all the patients underwent dopplerography of transvalvular flows in pulsed-wave and continuous-wave modes, and the velocity of the fibrous rings of mitral and tricuspid valves were determined.

Statistical processing of the material was carried out using the software package "Statistica 6.0" (StatSoft, Tulsa, OK., S.S.A.) and "Analyse-it for Microsoft Excel 4.80.1" (Analyse-it Software, Ltd.). The t-criterion of the Student, Mann-Whitney, Kruskal-Wallis, χ2 was used. The ROC-analysis was used to determine the cut-off value of quantitative indicators. The significance of differences was considered at the level of p<0.05.

Results. Using the ASE formula, the normal left ventricular geometry was determined significantly more often (43% vs. 26%, p = 0.0122) than when calculated by the Penn Convention formula. Concentric remodeling also probably prevailed when calculated by ASE (13% vs. 5%, p = 0.0495). When calculating using the Penn Convention method, the number of cases of eccentric hypertrophy was significantly higher (44% vs. 27%, p = 0.0128) than with the application of the ASE formula.

The use of the additional echographic criterion – the speed of the early movement of the medial fibrous ring MK <8 cm / s allows the same percentage distribution of patients with GC according to the types of LV geometry, regardless of the used formula for calculating MMLF (ASE or Penn Convention).

Conclusion. The formula for the calculation of the Penn Convention of the index of MMLV overestimates the degree of pathological changes in the myocardium in patients with arterial hypertension, mainly due to an increase in the specific gravity of cases of eccentric hypertrophy, while the formula for calculating the index of MMLV for ASE increases the number of patients with EH with normal LV geometry. The inverse correlation between the mass of the myocardial infarction and the speed of early motion of the medial fibrous ring of MK was found (r = -0,29; p = 0,004). Consideration of an additional criterion for the speed of the early movement of the medial fibrous ring Ea medial <8 cm / s completely alleviates the error in the distribution of types of geometry that arises when using only two criteria – the RST and the index of MMLV calculated by any formula (ASE or Penn Convention).

References

Levy, D., Garrison, R. J., Savage, D. D., Kannel, W. B., & Castelli, W. P. (1990). Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med, 322(22), 1561–1576. doi: 10.1056/NEJM199005313222203.

Schillaci, G., Verdecchia, P., Porcellati, C., Cuccurullo, O., Cosco, C., & Perticone, F. (2000). Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension. Hypertension, 35(2), 580–586.

Devereux, R. B., & Roman, M. J. (1995). Evaluation of cardiac and vascular structure by echocardiography and other noninvasive techniques. Hypertension: pathophysiolog, diagnosis, treatment. J.H. Laragh, B.M. Brenner (Editors.). New York.

Gottdiener, J. S., Bednarz, J., Devereux, R., Gardin, J., Klein, A., Manning, W. J., et al. (2004). American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am SocEchocardiogr, 17(10), 1086–119. doi: 10.1016/j.echo.2004.07.013.

Kovalyova, O. N., Yankevich, A. A., Nizhegorodceva, O. A., & Latoguz, Yu. I. (2005). Metodicheskie podhody k vyyavleniyu gipertrofii levogo zheludochka pri arterial´noj gipertenzii s ispol´zovaniem e´khokardiografii [The methodological approach to left ventricular hypertrophy determination in arterial hypertension by means of echocardiography]. Ukrainskyi kardiolohichnyi zhurnal, 4, 119–125. [in Russian].

Zadorozhnaya, M. P., & Razumov, V. V. (2016). Mnogochislennost´ kriteriev gipertrofii miokarda levogo zheludochka kak problema arterial´noj gipertonii [Multi-criteria of left ventricular hypertrophy as a problem of arterial hypertension]. Zdorov´e i obrazovanie v XXI veke, 2, 17–24. [in Russian].

Poltanova, M. V., Stuchkov, P. V., & Tseka, O. S. (2011). Ocenka pokazatelej doplerovskogo dvizheniya fibroznykh kolec atrioventrikulyarnykh klapanov v issledovanii funkcional´nogo sostoyaniya serdca u bol´nykh arterial´noj gipertoniej [Doppler parameters of fibrous ring movements of atrioventricular valves during heart examination of subjects with arterial hypertension]. Vestnik novykh medicsinskikh tekhnologij, 4, 105–109. [in Russian].

Galyavich, A. S., Rafikov, A. Yu., & Sayfullina, G. B. (2012). Sravnitel´nyj analiz dannykh ehokardiografii, multispiral´noj kompyuternoj tomografii i perfuzionnoj scintigrafii miokarda v ocenke massy miokarda levogo zheludochka [Comparative analysis of echocardiography, multispiral computed tomography, myocardial perfusion scintigraphy in left ventricular mass evaluation]. Kazanskij medicinskij zhurnal, 93(6), 855–858. [in Russian].

Vcrdecchia, P., Porcellati, C., Reboldi, G., Gattobigio, R., Borgioni, C., Pearson, T.A., & Ambrosio, G. (2001). Left ventricular hypertrophy asan independent predictor of acute cerebrovascular events in essential hypertension. Circulation, 104(17), 2039–2044.

Verma, A., Meris, A., Skali, H., Ghali, J. K., Arnold, J. M., Bourgoun, M., et al. (2008). Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study. JACC Cardiovasc Imaging, 1(5), 582–591. doi: 10.1016/j.jcmg.2008.05.012.

Katholi, R. E., & Couri, D. M. (2011). Left ventricular hypertrophy: major risk factor in patients with hypertension: update and practical clinical applications. Int J Hypertens, 2011, 495349. doi: 10.4061/2011/495349.

Ho, J. E., Lyass, A., Lee, D. S., Vasan, R. S., Kannel, W. B., Larson, M. G., & Levy, D. (2013). Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction. Circ Heart Fail, 6(2), 279–286. doi: 10.1161/CIRCHEARTFAILURE.112.972828.

Bluemke, D. A., Kxonmal, R. A., Lima, J. A., Liu, K., Olson, J., Burke, G. L., & Folsom, A. R. (2008). The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am CollCardiol, 52(25), 2148–2155. doi: 10.1016/j.jacc.2008.09.014.

Bang, C. N., Greve, A. M., Wachtell, K., & Kober, L. (2012). Global systolic load, left ventricular hypertrophy, and atrial fibrillation. Am Heart J, 164(4), el3. doi: http://dx.doi.org/10.1016/j.ahj.2012.07.017.

Andrikou, E., Tsioufis, C., Thomopoulos, C., Andrikou, I., Kasiakogias, A., Leontsinis, I., et al. (2012). Left ventricular mass index as a predictor of new-onset microalbuminuria in hypertensive subjec a prospective study. Am J Hypertens, 25(11), 1195–1201. doi: 10.1038/ajh.2012.109.

Marwick, T. H., Gillebert, T. C., Aurigemma, G., Chirinos, J., Derumeaux, G., Galderisiet al. (2015). Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). Eur Heart J Cardiovasc Imaging, 16(6), 577–605. doi: 10.1093/ehjci/jev076.

Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., et al. (2013). 2013 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, 31(7), 1281–1357. doi: 10.1097/01.hjh.0000431740.32696.cc.

Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., et al. (2006). Recommendations for chamber quantification. Eur J Echocardiogr, 7(2), 79–108. doi: 10.1016/j.euje.2005.12.014.

Devereux, R. B., Alonso, D. R., Lutas, E. M., Gottlieb, G. J., Campo, E., Sachs, I., & Reichek, N. (1986). Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol, 57(6), 450–8. doi: https://doi.org/10.1016/0002-9149(86)90771-X.

Devereux, R. B., & Reichek, N. (1977). Echocardiography determination of left ventricular mass in man: Anatomic validation of the method. Circulation, 55(4), 613–618. doi: https://doi.org/10.1161/01.CIR.55.4.613.

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1.
Syvolap VV, Novikov YV, Lysenko VA, Bogun AO. Features of estimation of left ventricular geometry in patients with arterial hypertension. Pathologia [Internet]. 2017Dec.22 [cited 2024Nov.23];(3). Available from: http://pat.zsmu.edu.ua/article/view/118306

Issue

No. 3 (2017)

Section

Original research

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