Changing perspectives in the echocardiographic approach of hypertensive heart disease

IntroductionJoint Guidelines of the European Society of Hypertension and European Society of Cardiology recommend the use of echo in arterial hypertension only when a more sensitive detection of left ventricular (LV) hypertrophy (LVH) than that provided by ECG is considered useful. This occurs in the presence of a high global cardiovascular risk. The assessment of LV diastolic and systolic function has not considered able to add prognostic information to LV mass.ObjectivesThe present review aims at the need of making more comprehensive the evaluation of the hypertensive heart The progression of hypertensive heart towards heart failure includes, in fact, alterations LV diastolic properties which are globally defined as diastolic dysfunction. The independent prognostic value of E/e’ ratio recently demonstrated in the hypertensive setting should encourage an assessment which combines standard Doppler mitral inflow with pulsed Tissue Doppler of mitral annulus and, possibly, left atrial volume index. The potential advantages of novel ultrasound imaging are evident. The predominant importance of longitudinal strain derived by Speckle Tracking Echocardiography is demonstrated in hypertensive patients and could be used to identify subclinical LV systolic dysfunction. The assessment of LV longitudinal systolic function by pulsed Tissue Doppler may be however considered more than an alternative. The quantitation of LV mass by real-time three-dimensional echocardiography appears very attractive because it is feasible, rapid in both acquisition and reading procedures and accurate in comparison with cardiac magnetic resonance but its use is limited by its high costs.ConclusionsAn exhaustive study of the hypertensive heart should include not only the estimation of LV mass and geometry but also the non invasive assessment of LV filling pressure and, possibly, of longitudinal systolic function.