title: Incremental value of ultrasonic tissue characterization (backscatter) in the evaluation of left ventricular myocardial structure and mechanics in essential arterial hypertension.
abstract: BACKGROUND
  Ultrasonic backscatter parameters were analyzed in hypertensive patients and divided into groups according to both severity of left ventricular hypertrophy (LVH) (group A: no LVH [n=52]; B: mild to moderate LVH [n=55]; and C: severe LVH [n=10]) and left ventricular geometry (normal geometry [n=44]; concentric remodeling [n=8]; concentric hypertrophy [n=25]; and eccentric hypertrophy [n=40]).
  
  
  RESULTS
  We studied 117 male, essential hypertensive patients and 19 normotensive, age-matched (40+/-5 years), healthy subjects who served as controls. Ambulatory and office blood pressure measurements were taken and 2-dimensional Doppler echocardiography and ultrasonic myocardial integrated backscatter (IBS) were performed. A group from the hypertensive study population (n=16) was observed after a period of pharmacological antihypertensive treatment to determine the behavior of backscatter parameters in relation to eventual regression of left ventricular mass (LVM). The cyclic variation index (CVIs) of the backscatter signal at the septum level was grouped according to each LVM level and was 29.4+/-9.3 (controls), 15+/-11 (group A), 9.5+/-10 (group B), and -1.5+/-8.6 (group C) (P<0.001). CVI septum values grouped according to left ventricular geometry were 15+/-11 (normal geometry), 12+/-7 (concentric remodeling), 7+/-11 (concentric hypertrophy), and 7.8+/-11 (eccentric hypertrophy) (P<0.01). Follow-up data demonstrate a significant reduction of LVM after therapy, as well as a significant increase in CVIs toward normal values.
  
  
  CONCLUSIONS
  Hypertensive patients with higher LVM had the worst prognosis; in fact, those patients had the most significant CVI alterations. Regression of LVM subsequent to chronic pharmacological therapy induces a normalization of ultrasonic backscatter parameters. Ultrasonic tissue characterization (backscatter) analysis could allow early identification of patients at risk of developing complications of hypertensive cardiopathy.
authors.affiliation: Cardiac and Thoracic Department, University of Pisa, Pisa, Italy. dibellov@ifc.cnr.it
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello
authors.forename: Davide
authors.initials: D
authors.lastname: Giorgi
authors.forename: Enrica
authors.initials: E
authors.lastname: Talini
authors.forename: Giulia
authors.initials: G
authors.lastname: Dell' Omo
authors.forename: Caterina
authors.initials: C
authors.lastname: Palagi
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Romano
authors.forename: Roberto
authors.initials: R
authors.lastname: Pedrinelli
authors.forename: Mario
authors.initials: M
authors.lastname: Mariani
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003094:Collagen / Q000032:analysis; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D020257:Ventricular Remodeling
chemical_list: D003094:Collagen