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Microalbuminuria, pulse pressure, left ventricular hypertrophy, and myocardial ultrasonic tissue characterization in essential hypertension

Microalbuminuria (UAE) may be considered a marker of systemic vascular dysfunction, while pulse pressure (PP) is an indicator of the stiffness of vascular conduits. Both these parame ters, together with left ventricular hypertrophy (LVH), are linked to cardiovascular morbidity in hypertensive patients. The aim of this study was the analysis of the possible relationships among UAE, PP, and LVH with ultrasonic myocardial textural parameters, which are altered in hypertensives patients. A group of male (n = 70) essential hypertensive patients (mean age: 58 ±7 yr) was analyzed with a group of age-comparable normotensive healthy subjects as controls (n = 32). Ambulatory blood pressure monitoring (ABPM) was performed with an oscil lometric monitor; UAE was measured by nephelometry. A conventional 2D-Doppler echocar diography (to analyze left ventricular mass: LVM) and a quantitative analysis of the echocar diographic digitized imaging with the use of a calibrated digitization system (to calculate the septum and the posterior wall textural parameters) were performed on all subjects. The myocardial mean gray level was calculated to derive the cyclic variation index (CVI). The CVI was significantly lower in hypertensives both for the septum (-16.3 ±22.8 vs 34.7 ±15.3%; p < 0.001 ) and for the posterior wall (-15.2 ±23.6 vs 38.2 ±15.4%; p < 0.001 ). A signifi cant negative correlation was found between logUAE and the CVI of the septum (r = -0.42; p<0.001), between the PP and the CVI of the septum (r = -0.40; p<0.002) and between the CVI and the LVM (r = -0.38; p<0.001). Multiple regression analysis having as dependent variable the CVI at septum level showed as significantly related independent variables: PP (p<0.01), logUAE (p < 0.001), and LVM (p<0.05) (multiple R: 0.76, squared multiple R: 0.57; p<0.001 ). It was found that LVM, logUAE, and PP are all correlated with textural parameters, and the CVI can be considered a sensitive parameter in the identification of an abnormal myocardial texture in hypertension. A high level of arterial stiffness and the presence of vascular dysfunc tion in essential hypertension could participate in the determination of myocardial alterations and permit the identification of patients with the worst prognosis in terms of morbidity or mortality due to cardiovascular events.

The potential prognostic value of ultrasonic characterization (videodensitometry) of myocardial tissue in essential arterial hypertension.

BackgroundLeft ventricular hypertrophy (LVH) and the geometric shape of the left ventricle are well-established important risk factors for cardiovascular morbidity and mortality in the hypertensive population. Videodensitometry is an alternate echocardiographic approach to the study of myocardial structural and functional alterations in essential hypertension. ObjectivesTo analyze the behavior of the ultrasonic videodensitometric parameter for various subgroups of a hypertensive population; first according to the severity of LVH (group A, without LVH; group B, with mild-to-moderate LVH; and group C, with severe LVH) and second according to geometric adaptation of left ventricle to pressure-volume overload of essential hypertension (group NG, normal geometry; group CR, concentric remodeling; group CH, concentric hypertrophy; and group EH, eccentric hypertrophy). MethodsFor 70 male, essential hypertensive patients and 32 normotensive healthy subjects matched for age (58 ± 7 years) and sex as controls (group N) we performed ambulatory blood pressure measurements for the evaluation of 24 h mean systolic and diastolic blood pressures, conventional two-dimensional Doppler echocardiography to evaluate left ventricular performance and left ventricular mass index, and digitization of left ventricular parasternal long-axis echocardiographic images. For regions of interest selected within the septum and the posterior wall, the mean gray levels were calculated at end-systole and end-diastole. The resulting values were used to estimate the percentage cyclic variation index (CVI). ResultsThe results according to left ventricular mass index were CVI for septum group N 34.7 ± 16.3%; group A −0.18 ± 16%, group B −13 ± 19%, and group C −22 ± 12% (P  < 0.001); and CVI of posterior wall, group N 38.2 ± 15.4%, group A −0.75 ± 16%, group B −16 ± 16% and group C −16 ± 13% (P  < 0.001). According to left ventricular geometry CVI for septum were group NG 0.6 ± 24%, group CR 1.9 ± 17%; group CH −25.4 ± 18%, and group EH −17.1 ± 20% (P  < 0.01). CVI of posterior wall were group NH −5.8 ± 24%, group CR 6.4 ± 23%, group CH −29 ± 20%, group EH −20 ± 21 (P  < 0.01). ConclusionsOur results demonstrate that subjects with high left ventricular masses and those with concentric hypertrophy, which have the worst prognostic impacts, have the most significant changes in CVI. Furthermore, videodensitometric findings are quite different even among the subgroups with mild-to-moderate left ventricular hypertrophy and eccentric hypertrophy. Therefore this videodensitometric approach could provide some useful information for better definition of cardiovascular risk in hypertension.