Role of Echocardiography
Hypertensive heart disease represents a spectrum of changes in the heart geometry and functions as an adaptation to long-term increased blood pressure. These alterations in the heart function and structure, along with associated conditions, such as ischem
- PDF / 906,194 Bytes
- 16 Pages / 439.37 x 666.142 pts Page_size
- 0 Downloads / 201 Views
11
Silvia Iancovici and Maria Dorobantu
11.1 I ntroduction: Role of Echocardiography in Defining Heart Failure Hypertensive heart disease(HHD) represents one of the etiologies of heart failure [1] (HF); the classic paradigm of progression from HHD to HF is that HHD leads to LV hypertrophy and diastolic dysfunction, followed by LV dilatation and decreasing ejection fraction (EF) [2]. Diastolic and systolic dysfunction of the left ventricle may coexist, and the sequence of appearance may differ between patients; diastolic dysfunction may occur in the absence of systolic dysfunction; however when systolic dysfunction is present, virtually there is some degree of impaired diastolic function, as well [3]. To a certain extent, it is of relevance to differentiate between a large, dilated LV with poor ejection fraction that defines systolic HF and a small, hypertrophied LV with normal EF and diastolic dysfunction, as found in diastolic HF. The new HF guidelines redefined systolic and diastolic HF as HF with reduced ejection fraction (HFrEF) when EF 50% [1, 4]. For the definition of HFpEF, the European guidelines also include the presence of signs and symptoms of HF and elevated levels of natriuretic peptides and at least one of the following: relevant structural heart disease (LV hypertrophy or left atrial enlargement) or the presence of diastolic dysfunction [1]. In the case of an EF between 40 and 49%, the American guidelines describe the entity of HFpEF borderline [4]; meanwhile the European guidelines define the HF
S. Iancovici Clinical Emergency Hospital of Bucharest, Bucharest, Romania M. Dorobantu (*) Clinical Emergency Hospital of Bucharest, Bucharest, Romania ‘Carol Davila’ University of Medicine and Pharmacy in Bucharest, Bucharest, Romania © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_11
169
170
S. Iancovici and M. Dorobantu
with midrange EF (HRmrEF) that also has to associate elevated levels of natriuretic peptides and at least one of the following: relevant structural heart disease (LV hypertrophy or left atrial enlargement) or the presence of diastolic dysfunction [1]. In addition, the American 2013 guidelines have also described the entity of HFpEF improved as a subset of patients with HFpEF who previously had HFrEF [4]. Therefore, in the presence of clinical signs of HF, echocardiography represents the main investigation utilized to discriminate between the different types of HF.
11.2 E valuation of Left Ventricular (LV) Hypertrophy and Cardiac Mass The evaluation of left ventricular hypertrophy, including LV mass measurement and assessing LV geometry, is the major role of echocardiography in hypertensive patients [5]. It is essential to determine LV mass and to establish the type of LV hypertrophy.
11.2.1 LV Measurements Using the parasternal long-axis acoustic window at the level of the LV minor axis, the following linear measurements of LV can b
Data Loading...
