Hypertensive Heart Failure

Published on 21/06/2015 by admin

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Last modified 21/06/2015

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5 Hypertensive Heart Failure

How to Evaluate LV Mass

Linear Measurements

Key Points

3D Measurement of LVM

Key Points

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Figure 5-7 3D measurement of LVM has lower interobserver variability than 2D measurement of LVM. Additionally, 3D measurement of LVM has high agreement with measurement by cardiac magnetic resonance imaging (CMRI).

(Reproduced with permission from Mor-Avi V, Sugeng L, Weinert L, et al. Fast measurement of left ventricular mass with real-time three-dimensional echocardiography: Comparison with magnetic resonance imaging. Circulation. 2004;110:1814-1818.)

Definition of LVH and Abnormal LV Geometry

LV Geometry (Figure 5-8)

Key Points

LV geometry has incremental value for prognostication of mortality (Figure 5-10) and to heart failure events, all-cause mortality, and composite cardiac events (Figures 5-11 and 5-12).
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Figure 5-10 Relationship of LV geometry to mortality in patients with uncomplicated hypertension. Concentric hypertrophy (CH) carries the greatest risk, followed by eccentric hypertrophy (EH) and concentric remodeling (CR). NL, normal.

(Adapted with permission from 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;114:345-352.)

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Figure 5-11 LVM and LVH raise the risk of incident heart failure events in the Multi-Ethnic Study of Atherosclerosis.

(Reprinted with permission from Bluemke DA, Kronmal RA, Lima JA, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: The MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol. 2008;52:2148-2155.)

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Figure 5-12 Relationship of LV geometry to all-cause mortality and composite cardiac events (cardiovascular death, recurrent myocardial infarction, heart failure, stroke, and resuscitated sudden death) post myocardial infarction in the VALIANT study. Concentric hypertrophy has the highest risk, followed by eccentric hypertrophy and then concentric remodeling.

(Reproduced with permission from Verma A, Meris A, Skali H, et al. Prognostic implications of left ventricular mass and geometry following myocardial infarction: The VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study. JACC Cardiovasc Imaging. 2008;1:582-591.)

Clinical Vignettes