title: Regression of hypertensive myocardial hypertrophy does not affect ultrasonic myocardial reflectivity: a tissue characterization study.
abstract: OBJECTIVE
  Ultrasonic backscatter from the myocardial walls is directly related to the morphometrically or biochemically evaluated collagen content in man, and shows a normal pattern of quantitatively assessed ultrasonic backscatter in hypertensive patients, even in the presence of left ventricular hypertrophy. Whether the pharmacologically induced regression of left ventricular hypertrophy in hypertensive patients is accompanied by a disproportionate increase in relative connective tissue content is not yet known. The objective of the present study was to assess the effects of regression of left ventricular hypertrophy on the quantitatively evaluated myocardial reflectivity in essential hypertensives.
  
  
  METHODS
  We evaluated 19 mild-to-moderate essential hypertensives with echocardiographically assessed left ventricular hypertrophy, before and after 8 months' effective antihypertensive therapy with 20-40 mg enalapril once a day, associated with diuretics or calcium antagonists, or both, in six patients to achieve optimal blood pressure control. Using a modified echo machine developed in the Institute of Clinical Physiology, Pisa, an on-line radio-frequency analysis was performed to obtain quantitative operator-independent measurements of the integrated backscatter signal of the ventricular septum and the posterior wall. The integrated values of the radio-frequency signal from the myocardial walls were normalized for those from the pericardial interface and were expressed as percentages (integrated backscatter index).
  
  
  RESULTS
  In comparison with baseline, the treated hypertensives showed significant decreases in mean blood pressure, left ventricular mass index, and septal and posterior wall thickness. However, integrated backscatter index values were similar at baseline and after therapy for both the septum and the posterior wall.
  
  
  CONCLUSIONS
  Antihypertensive therapy with enalapril does not increase myocardial reflectivity, although it does induce regression of left ventricular hypertrophy. This suggests that, in accord with experimental data, regression of hypertrophy is achieved by enalapril through a proportionate regression of the myocyte and connective tissue components of the myocardium.
authors.affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: A R
authors.initials: AR
authors.lastname: Lucarini
authors.forename: G
authors.initials: G
authors.lastname: Gigli
authors.forename: F
authors.initials: F
authors.lastname: Lattanzi
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: A
authors.initials: A
authors.lastname: Mazzarisi
authors.forename: M
authors.initials: M
authors.lastname: Iannetti
authors.forename: L
authors.initials: L
authors.lastname: Landini
mesh_terms: D006332:Cardiomegaly / Q000000981:diagnostic imaging* / Q000209:etiology*; D004452:Echocardiography; D006346:Heart Septum / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D012542:Scattering, Radiation