06:28pm Tuesday 26 September 2017

First international advice on echo assessment of hypertensive heart damage

The first international recommendations on the use of echocardiography to evaluate the damaging effects of hypertension on the heart are published today in European Heart Journal – Cardiovascular Imaging.1

Hypertension
Non-invasive Imaging: Echocardiography 

Sophia Antipolis – The first international recommendations on the use of echocardiography to evaluate the damaging effects of hypertension on the heart are published today in European Heart Journal – Cardiovascular Imaging.1

The joint paper from the European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology (ESC) and the American Society of Echocardiography (ASE) comes as research has cemented the value of echocardiography in the assessment of left ventricular (LV) hypertrophy and LV systolic and diastolic function, the principal areas of heart injury caused by hypertension.

Professor Jose L Zamorano, EACVI co-chair of the writing group, said: “Hypertension is a major risk factor for cardiovascular diseases including coronary heart disease and stroke. It occurs in 30–45% of the general population in Europe and rises rapidly with ageing so it is a growing problem.2

Professor Thomas H. Marwick, ASE co-chair of the writing group, said: “The left ventricle is one of the main target organs of hypertension and assessment of its structure and function using echocardiography can help predict prognosis. This is the first international recommendation paper on how to use echocardiography in this situation.”

The paper published today outlines:
•    The pathophysiology of the heart’s response to hypertension
•    How to measure left ventricular mass, geometry and function
•    The effects of hypertensive treatment on the heart
•    Recommendations on the use of echocardiography to assess heart damage caused by hypertension.

Professor Zamorano said: “Advances in echocardiographic techniques have improved our understanding of the hypertensive heart. For example, in patients with hypertension the type of left ventricular remodelling predicts the incidence of cardiovascular events.”

He added: “There is increasing recognition that left ventricular hypertrophy identified by echocardiography should prompt more aggressive lifestyle modification in patients with pre-hypertension. In addition, it may be important in young adults whose lifetime risk for hypertension is underestimated by many models for risk stratification.”

The authors recommend that for patients with hypertension:
•    Left ventricular mass should be reported to evaluate prognosis. Advice is given on which echocardiographic techniques to use
•    Description of left ventricular geometry should be a standard component of the echocardiography report
•    Cardiac magnetic resonance (CMR) imaging should be used to identify non-hypertrophic causes of left ventricular thickening
•    Echocardiography should be used to assess aortic dimensions since hypertension contributes to aortic disease
•    Left ventricular function assessment should be included in echocardiography reports
•    Echocardiography reports should include grade of diastolic function, left atrial volume and left ventricular filling pressure.

Professor Marwick said:

“The paper published today details how echocardiography should be used to characterise heart damage in patients with hypertension. More research is needed to show how clinicians could use this information to guide treatment decisions and monitor response to therapy. For example, the echocardiographic finding of left ventricular hypertrophy in patients with established hypertension could indicate that patients should be prescribed ACE inhibitors or calcium channel blockers.”

Professor Zamorano concluded:

“We hope our recommendations provide clarity to clinicians on how to make the best use of modern echocardiographic techniques to identify the type and extent of heart damage in their patients with hypertension.”

ENDS

References

1 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). European Heart Journal – Cardiovascular Imaging. 2015 here

22013 ESH/ESC Guidelines for the management of arterial hypertension. European Heart Journal. 2013;34: 2159–2219. doi:10.1093/eurheartj/eht151

Notes to editor

About the European Association of Cardiovascular Imaging
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean.

The European Association of Cardiovascular Imaging (formerly EAE) is a registered branch of the ESC. Its aim is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound imaging modalities in Europe.

About the American Society of Echocardiography
The American Society of Echocardiography (ASE) is an organisation of professionals committed to excellence in cardiovascular ultrasound and its application to patient care through education, advocacy, research, innovation and service to our members and the public.


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