Abstract
Hypertension is a condition characterized by pressure and/or volume overloads and echocardiography is helpful and feasible to understand hemodynamic mechanisms. Echocardiographic information is sometimes critical and susceptible of modifying decision making. In this review, we provide detailed descriptions of the parameters that can be derived from a standard transthoracic echocardiogram, including some more recent techniques. We will also explain how each parameter might have impact in the evaluation of the hypertensive patient and give indications on when to refer patients to echo-labs, which parameters are critical and which ones might be redundant, and how to use the information obtained in the report. Cardiac geometry, LV systolic and diastolic function, LV pump performance, output impedance and left atrial function are parameters that might be altered in arterial hypertension, but not necessarily doctors need the whole information for decision making. The critical measures are provided.
Similar content being viewed by others
References
Baicu CF, Zile MR, Aurigemma GP, Gaasch WH. Left ventricular systolic performance, function, and contractility in patients with diastolic heart failure. Circulation. 2005;111:2306–12.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study [see comments]. N Engl J Med. 1990;322:1561–6.
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;114:345–52.
de Simone G, Izzo R, Aurigemma GP, et al. Cardiovascular risk in relation to a new classification of hypertensive left ventricular geometric abnormalities. J Hypertens. 2015;33:745–54 (discussion 754).
de Simone G, Izzo R, Chinali M, et al. Does information on systolic and diastolic function improve prediction of a cardiovascular event by left ventricular hypertrophy in arterial hypertension? Hypertension. 2010;56:99–104.
Mancusi C, Losi MA, Izzo R, et al. Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: the Campania Salute Network. Eur J Prev Cardiol. 2018;25:235–43.
Devereux RB, Wachtell K, Gerdts E, et al. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004;292:2350–6.
Devereux RB, Alderman MH. Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation. 1993;88:1444–55.
Khouri MG, Peshock RM, Ayers CR, de Lemos JA, Drazner MH. A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: the Dallas heart study. Circ Cardiovasc Imaging. 2010;3:164–71.
Tsao CW, Gona PN, Salton CJ, et al. Left ventricular structure and risk of cardiovascular events: a Framingham Heart Study Cardiac Magnetic Resonance Study. J Am Heart Assoc. 2015;4:e002188.
Schillaci G, de Simone G, Reboldi G, Porcellati C, Devereux RB, Verdecchia P. Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension. J Hypertens. 2002;20:1519–25.
Pouleur AC, le Polain de Waroux JB, Pasquet A, et al. Assessment of left ventricular mass and volumes by three-dimensional echocardiography in patients with or without wall motion abnormalities: comparison against cine magnetic resonance imaging. Heart. 2008;94:1050–7.
Qin JX, Jones M, Travaglini A, et al. The accuracy of left ventricular mass determined by real-time three-dimensional echocardiography in chronic animal and clinical studies: a comparison with postmortem examination and magnetic resonance imaging. J Am Soc Echocardiogr. 2005;18:1037–43.
Cioffi G, Rossi A, Targher G, et al. Usefulness of subclinical left ventricular midwall dysfunction to predict cardiovascular mortality in patients with type 2 diabetes mellitus. Am J Cardiol. 2014;113:1409–14.
de Simone G, Devereux RB, Koren MJ, Mensah GA, Casale PN, Laragh JH. Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension. Circulation. 1996;93:259–65.
Saito K, Okura H, Watanabe N et al. Comprehensive evaluation of left ventricular strain using speckle tracking echocardiography in normal adults: comparison of three-dimensional and two-dimensional approaches. J Am Soc Echocardiogr 2009.
Shah AM, Claggett B, Sweitzer NK, et al. Prognostic importance of impaired systolic function in heart failure with preserved ejection fraction and the impact of spironolactone. Circulation. 2015;132:402–14.
Lonnebakken MT, Izzo R, Mancusi C, et al. Left ventricular hypertrophy regression during antihypertensive treatment in an outpatient clinic (the Campania Salute Network). J Am Heart Assoc. 2017;6(3). pii: e004152. https://doi.org/10.1161/JAHA.116.004152.
de Simone G, Devereux RB, Izzo R, et al. Lack of reduction of left ventricular mass in treated hypertension: the strong heart study. J Am Heart Assoc. 2013;2:e000144.
de Simone G, Devereux RB, Kimball TR, et al. Interaction between body size and cardiac workload: influence on left ventricular mass during body growth and adulthood. Hypertension. 1998;31:1077–82.
Devereux RB, de Simone G, Ganau A, Roman MJ, Wallerson DC. Left ventricular mass as an indicator of hemodynamic load in hypertension. J Cardiovasc Pharmacol. 1991;17(Suppl 2):S33.
de Simone G, Verdecchia P, Schillaci G, Devereux RB. Clinical impact of various geometric models for calculation of echocardiographic left ventricular mass [see comments]. J Hypertens. 1998;16:1207–14.
Marwick TH, Gillebert TC, Aurigemma G, et al. 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)dagger. Eur Heart J Cardiovasc Imaging. 2015;16:577–605.
Dewey FE, Rosenthal D, Murphy DJ Jr, Froelicher VF, Ashley EA. Does size matter? Clinical applications of scaling cardiac size and function for body size. Circulation. 2008;117:2279–87.
Kuznetsova T, Haddad F, Tikhonoff V, et al. Impact and pitfalls of scaling of left ventricular and atrial structure in population-based studies. J Hypertens. 2016;34:1186–94.
de Simone G, Pasanisi F, Ferrara AL, et al. Relative fat-free mass deficiency and left ventricular adaptation to obesity: the Strong Heart Study. IntJ Cardiol. 2013;168:729–33.
de Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol. 1992;20:1251–60.
de Simone G, Kizer JR, Chinali M, et al. Normalization for body size and population-attributable risk of left ventricular hypertrophy. The Strong Heart Study. Am J Hypertens. 2005;18:191–6.
de Simone G, Devereux RB, Maggioni AP, Gorini M, de Divitiis O, Verdecchia P. Different normalizations for body size and population attributable risk of left ventricular hypertrophy: the MAVI study. Am J Hypertens. 2005;18:1288–93.
de Simone G, Daniels SR, Kimball TR, et al. Evaluation of concentric left ventricular geometry in humans: evidence for age-related systematic underestimation. Hypertension. 2005;45:64–8.
Chinali M, Aurigemma GP. Refining patterns of left ventricular hypertrophy using cardiac MRI: “brother, can you spare a paradigm?”. Circ Cardiovasc Imaging. 2010;3:129–31.
Lembo MER, Santoro C, Lo Iudice F. Schiano-Lomoriello V, Fazio V, Grimaldi MG, Trimarco B, de Simone G, Galderisi M. Three dimensional echocardiographic ventricular mass/end-diastolic volume ratio in native hypertensive patients: relation between stroke volume and geometry. J Hypertens. 2018. https://doi.org/10.1097/HJH.0000000000001717 (Epub ahead of print).
Grossman W, Jones D, McLaurin LP. Wall stress and patterns of hypertrophy in the human left ventricle. JClinInvest. 1975;56:56–64.
de Simone G, Verdecchia P, Pede S, Gorini M, Maggioni AP. Prognosis of inappropriate left ventricular mass in hypertension: the MAVI study. Hypertension. 2002;40:470–6.
Chinali M, De Marco M, D’addeo G, et al. Excessive increase in left ventricular mass identifies hypertensive subjects with clustered geometric and functional abnormalities. J Hypertens. 2007;25:1073–8.
Douglas PS. The left atrium: a biomarker of chronic diastolic dysfunction and cardiovascular disease risk. J Am Coll Cardiol. 2003;42:1206–7.
Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002;90:1284–9.
Canciello G, de Simone G, Izzo R, et al. Validation of left atrial volume estimation by left atrial diameter from the parasternal long-axis view. J Am Soc Echocardiogr. 2017;30:262–9.
de Simone G, Devereux RB, Celentano A, Roman MJ. Left ventricular chamber and wall mechanics in the presence of concentric geometry. J Hypertens. 1999;17:1001–6.
de Simone G, Devereux RB. Rationale of echocardiographic assessment of left ventricular wall stress and midwall mechanics in hypertensive heart disease. EurJ Echocardiogr. 2002;3:192–8.
Galderisi M, Esposito R, Schiano-Lomoriello V, et al. Correlates of global area strain in native hypertensive patients: a three-dimensional speckle-tracking echocardiography study. Eur Heart J Cardiovasc Imaging. 2012;13:730–8.
Mor-Avi V, Lang RM, Badano LP, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr. 2011;24:277–313.
Notomi Y, Lysyansky P, Setser RM, et al. Measurement of ventricular torsion by two-dimensional ultrasound speckle tracking imaging. J Am Coll Cardiol. 2005;45:2034–41.
Lembo M, Esposito R, Li F, et al. Impact of pulse pressure on left ventricular global longitudinal strain in normotensive and newly diagnosed, untreated hypertensive patients. J Hypertens. 2016;34:1201–7.
Galderisi M, Trimarco B. Global longitudinal strain: a novel hallmark of cardiac risk in arterial hypertension. J Hypertens. 2016;34:1050–1.
Contaldi C, Imbriaco M, Alcidi G, et al. Assessment of the relationships between left ventricular filling pressures and longitudinal dysfunction with myocardial fibrosis in uncomplicated hypertensive patients. Int J Cardiol. 2016;202:84–6.
Modin D, Biering-Sorensen SR, Mogelvang R, Landler N, Jensen JS, Biering-Sorensen T. Prognostic value of echocardiography in hypertensive versus nonhypertensive participants from the general population. Hypertension. 2018;71:742–51.
De Marco M, Gerdts E, Mancusi C, et al. Influence of left ventricular stroke volume on incident heart failure in a population with preserved ejection fraction (from the Strong Heart Study). Am J Cardiol. 2017;119:1047–52.
de Simone G, Devereux RB, Daniels SR, et al. Stroke volume and cardiac output in normotensive children and adults. Assessment of relations with body size and impact of overweight. Circulation. 1997;95:1837–43.
de Simone G, Devereux RB, Ganau A, et al. Estimation of left ventricular chamber and stroke volume by limited M-mode echocardiography and validation by two-dimensional and Doppler echocardiography. Am J Cardiol. 1996;78:801–7.
Mancusi C, Gerdts E, de Simone G, et al. Higher pulse pressure/stroke volume index is associated with impaired outcome in hypertensive patients with left ventricular hypertrophy the LIFE study. Blood Press. 2017;26:150–5.
Mancusi C, Gerdts E, dS G, et al. Impact of isolated systolic hypertension on normalization of left ventricular structure during antihypertensive treatment (the LIFE study). Blood Press. 2014;23:206–12.
Chemla D, Hebert JL, Coirault C, et al. Total arterial compliance estimated by stroke volume-to-aortic pulse pressure ratio in humans. Am J Physiol. 1998;274:H500–5.
Berkenstadt H, Friedman Z, Preisman S, Keidan I, Livingstone D, Perel A. Pulse pressure and stroke volume variations during severe haemorrhage in ventilated dogs. Br J Anaesth. 2005;94:721–6.
Devereux RB, dS G, Arnett DK, et al. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons >/=15 years of age. Am J Cardiol. 2012;110:1189–94.
Milan A, Avenatti E, Tosello F, et al. Aortic root dilatation in essential hypertension: prevalence according to new reference values. J Hypertens. 2013;31:1189–95.
de Simone G, Roman MJ, De Marco M, et al. Hemodynamic correlates of abnormal aortic root dimension in an adult population: The Strong Heart Study. J Am Heart Assoc. 2015;4:e002309.
Aljaroudi W, Alraies MC, Halley C, et al. Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction. Circulation. 2012;125:782–8.
de Simone G, Greco R, Mureddu G, et al. Relation of left ventricular diastolic properties to systolic function in arterial hypertension. Circulation. 2000;101:152–7.
de Simone G, Kitzman DW, Chinali M, et al. Left ventricular concentric geometry is associated with impaired relaxation in hypertension: the HyperGEN study. Eur Heart J. 2005;26:1039–45.
Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17:1321–60.
Lancellotti P, Galderisi M, Edvardsen T, et al. Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imaging. 2017;18:961–8.
Schillaci G, Pasqualini L, Verdecchia P, et al. Prognostic significance of left ventricular diastolic dysfunction in essential hypertension. J Am Coll Cardiol. 2002;39:2005–11.
Chinali M, Aurigemma G, de Simone G, et al. Mitral E wave deceleration time to peak E velocity ratio and cardiovascular outcome in hypertensive patients during anti-hypertensive treatment (from the LIFE Echo-Substudy). Am J Cardiol. 2009;104:1098–104.
Galderisi M, Rapacciuolo A, Esposito R, et al. Site-dependency of the E/e’ ratio in predicting invasive left ventricular filling pressure in patients with suspected or ascertained coronary artery disease. Eur Heart J Cardiovasc Imaging. 2013;14:555–61.
Gottdiener JS, Kitzman DW, Aurigemma GP, Arnold AM, Manolio TA. Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons > or = 65 years of age (the cardiovascular health study). Am J Cardiol. 2006;97:83–9.
Eshoo S, Semsarian C, Ross DL, Thomas L. Left atrial phasic volumes are modulated by the type rather than the extent of left ventricular hypertrophy. J Am Soc Echocardiogr. 2010;23:538–44.
Eshoo S, Ross DL, Thomas L. Impact of mild hypertension on left atrial size and function. Circ Cardiovasc Imaging. 2009;2:93–9.
Chinali M, de Simone G, Liu JE, et al. Left atrial systolic force and cardiac markers of preclinical disease in hypertensive patients: the Hypertension Genetic Epidemiology Network (HyperGEN) Study. Am J Hypertens. 2005;18:899–905.
Khan UA, de Simone G, Hill J, Tighe DA, Aurigemma GP. Depressed atrial function in diastolic dysfunction: a speckle tracking imaging study. Echocardiography. 2013;30:309–16.
Mancia G, Fagard R, Narkiewicz K, et al. 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). Eur Heart J. 2013;34:2159–219.
Whelton PK, Carey RM, Aronow WS, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017. pii: HYP.0000000000000065. https://doi.org/10.1161/HYP.0000000000000065 (Epub ahead of print).
Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310:959–68.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
de Simone, G., Mancusi, C., Esposito, R. et al. Echocardiography in Arterial Hypertension. High Blood Press Cardiovasc Prev 25, 159–166 (2018). https://doi.org/10.1007/s40292-018-0259-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40292-018-0259-y