New echocardiographic technologies in the clinical management of hypertensive heart disease.
Doppler echocardiography is a fundamental instrument to understand heart damage during essential arterial hypertension. Left ventricular (LV) hypertrophy may also be conveniently studied in its morphological and functional aspects by ultrasound application. Echocardiography can also provide important morphological and functional information in hypertensive patients for therapeutic management and prognostic stratification. In recent years, echocardiography has been enriched by very refined techniques that are capable of studying the physiopathological intramyocardial phenomena: (i) tissue Doppler (which studies intramyocardial velocities and time intervals and allows the analysis of strain and strain rate); (ii) integrated backscatter (which analyzes variations of myocardial reflectivity in decibels); (iii) transthoracic Doppler derived coronary flow reserve (which quantifies the vasodilator response of coronary velocities to a hyperaemic stimulation); (iv) myocardial echo-contrast-echocardiography (which studies the kinetics of ultrasound contrast microbubbles at the intramyocardial level); and (v) real-time three-dimensional (3-D) echocardiography [which allows a more precise evaluation of left ventricular (LV) volumes and LV mass]. These new methodological approaches have recently been used in the hypertensive clinical setting to provide a deeper knowledge of the complex physiopathological and histopathological mechanisms underlying the modifications induced by arterial hypertension at the myocardial tissue level (myocytes, collagen, microcirculation). This review shows the advancement of high-tech ultrasound applied to hypertensive heart disease, pointing out limitations and incremental potentialities in comparison with conventional echocardiography.
Di Bello
Vitantonio
V
Cardiac Ultrasound Laboratory, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy. vdibello@med.unipi.it
Galderisi
Maurizio
M
de Gregorio
Cesare
C
Ansalone
Gerardo
G
Dini
Frank Lloyd
FL
Di Salvo
Giovanni
G
Gallina
Sabina
S
Mele
Donato
D
Sciomer
Susanna
S
Montisci
Roberta
R
Mondillo
Sergio
S
Marino
Paolo Nicola
PN
D003326:Coronary Circulation; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D019560:Echocardiography, Three-Dimensional; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016277:Ventricular Function, Left