title: The septal bulge--an early echocardiographic sign in hypertensive heart disease.
abstract: Patients in the early stage of hypertensive heart disease tend to have normal echocardiographic findings. The aim of this study was to investigate whether pathology-specific echocardiographic morphologic and functional parameters can help to detect subclinical hypertensive heart disease. One hundred ten consecutive patients without a history and medication for arterial hypertension (AH) or other cardiac diseases were enrolled. Standard echocardiography and two-dimensional speckle-tracking-imaging analysis were performed. Resting blood pressure (BP) measurement, cycle ergometer test (CET), and 24-hour ambulatory BP monitoring (ABPM) were conducted. Patients were referred to "septal bulge (SB)" group (basal-septal wall thickness ≥ 2 mm thicker than mid-septal wall thickness) or "no-SB" group. Echocardiographic SB was found in 48 (43.6%) of 110 patients. In this SB group, 38 (79.2%) patients showed AH either by CET or ABPM. In contrast, in the no-SB group (n = 62), 59 (95.2%) patients had no positive test for AH by CET or ABPM. When AH was solely defined by resting BP, SB was a reasonable predictive sign for AH (sensitivity 73%, specificity 76%). However, when AH was confirmed by CET or ABPM the echocardiographic SB strongly predicted clinical AH (sensitivity 93%, specificity 86%). In addition, regional myocardial deformation of the basal-septum in SB group was significantly lower than in no-SB group (14 ± 4% vs. 17 ± 4%; P < .001). In conclusion, SB is a morphologic echocardiographic sign for early hypertensive heart disease. Sophisticated BP evaluation including resting BP, ABPM, and CET should be performed in all patients with an accidental finding of a SB in echocardiography.
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany; Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany.
authors: Philipp Daniel
authors: PD
authors: Gaudron
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany; Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany.
authors: Dan
authors: D
authors: Liu
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany.
authors: Friederike
authors: F
authors: Scholz
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany; Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany.
authors: Kai
authors: K
authors: Hu
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany.
authors: Christiane
authors: C
authors: Florescu
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany; Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany.
authors: Sebastian
authors: S
authors: Herrmann
authors: ICREA, Universitat Pompeu Fabra, Barcelona, Spain; Department of Cardiovascular Diseases, K.U. Leuven, Belgium.
authors: Bart
authors: B
authors: Bijnens
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany; Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany.
authors: Georg
authors: G
authors: Ertl
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany; Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany.
authors: Stefan
authors: S
authors: Störk
authors: Department of Internal Medicine I, University of Würzburg, Bavaria, Germany; Comprehensive Heart Failure Center, University of Würzburg, Bavaria, Germany; Medical Clinic II, Katharinen-Hospital, Unna, Germany. Electronic address: f.weidemann@katharinen-hospital.de.
authors: Frank
authors: F
authors: Weidemann
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D012680:Sensitivity and Specificity
keywords: Septal bulge; blood pressure monitoring; echocardiography; heart disease; hypertension