Ultrasonic myocardial texture versus Doppler analysis in hypertensive heart: a preliminary study.

-Doppler-derived parameters of transmitral flow are useful indices of diastolic dysfunction in the hypertensive heart. Different degrees of myocardial involvement in hypertensive heart can be detected by videodensitometric myocardial textural analysis. The aim of this study was to compare Doppler-derived and ultrasonic videodensitometric parameters in the differentiation of healthy hearts from hypertensive hearts. We compared a group of age-matched (59+/-9 years) male essential hypertensive patients (n=53) with normotensive healthy subjects as controls (n=32). All subjects provided ambulatory blood pressure measurements for the evaluation of 24-hour mean systolic and diastolic blood pressure. A transmitral flow Doppler analysis was performed on all subjects. A quantitative analysis of the echocardiographic digitized imaging was performed with the help of a calibrated digitization system to calculate the septum and the posterior wall textural parameters. The myocardial mean gray level (MGL) was calculated to derive the cyclic variation index (CVI): (MGLend-diastolic-MGLend-systolic)/MGLend-diastolic x100. When compared with controls, the hypertensive patients showed a significantly lower CVI for both septum (-11.1+/-26.8% versus 34. 7+/-16.3%; P<0.001) and posterior wall (-11.2+/-27.6% versus 38. 2+/-15.4%; P<0.001). Individual analyses for the ratio of peak transmitral flow velocity in early diastole to the peak transmitral flow velocity in late diastole showed that only 24% of the patients (13/53) were discriminated from normal subjects by this parameter. Individual analyses for CVI, however, at both septum and posterior wall levels, showed that 74% of the patients (39/53) were discriminated from normal subjects by this second parameter. In comparison with Doppler-derived indices of diastolic filling, the videodensitometric parameters showed a significantly higher ability to discriminate between hypertensive subjects and normal controls.

[1]  E. Picano,et al.  Cyclic variation in myocardial gray level as a marker of viability in man. A videodensitometric study. , 1996, European heart journal.

[2]  C Giusti,et al.  Ultrasonic videodensitometric analysis of two different models of left ventricular hypertrophy. Athlete's heart and hypertension. , 1997, Hypertension.

[3]  J S Janicki,et al.  Collagen network remodelling and diastolic stiffness of the rat left ventricle with pressure overload hypertrophy. , 1988, Cardiovascular research.

[4]  L. Landini,et al.  Increased echodensity of transiently asynergic myocardium in humans: a novel echocardiographic sign of myocardial ischemia. , 1993, Journal of the American College of Cardiology.

[5]  G. Schillaci,et al.  Variability between current definitions of 'normal' ambulatory blood pressure. Implications in the assessment of white coat hypertension. , 1992, Hypertension.

[6]  E. Sandoya,et al.  Ambulatory Blood Pressure , 1999 .

[7]  J. S. Janicki,et al.  Patterns of myocardial fibrosis. , 1989, Journal of molecular and cellular cardiology.

[8]  J. Laragh,et al.  Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. , 1992, Journal of the American College of Cardiology.

[9]  J. G. Miller,et al.  Anisotropy of the ultrasonic backscatter of myocardial tissue: I. Theory and measurements in vitro. , 1988, The Journal of the Acoustical Society of America.

[10]  S. M. Collins,et al.  Assessment of fibrosis in infarcted human hearts by analysis of ultrasonic backscatter. , 1985, Circulation.

[11]  K. R. Anderson,et al.  Histopathological types of cardiac fibrosis in myocardial disease , 1979, The Journal of pathology.

[12]  E. O’Brien,et al.  Clinical trials with ambulatory blood pressure monitoring: fewer patients needed? , 1994, The Lancet.

[13]  A J Tajik,et al.  Feasibility of identifying amyloid and hypertrophic cardiomyopathy with the use of computerized quantitative texture analysis of clinical echocardiographic data. , 1989, Journal of the American College of Cardiology.

[14]  J. Laragh,et al.  Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. , 1994, Journal of the American College of Cardiology.

[15]  B. Strauer,et al.  Structural and functional alterations of the intramyocardial coronary arterioles in patients with arterial hypertension. , 1993, Circulation.

[16]  J. S. Janicki,et al.  Reactive and reparative fibrillar collagen remodelling in the hypertrophied rat left ventricle: two experimental models of myocardial fibrosis. , 1990, Cardiovascular research.

[17]  S. M. Collins,et al.  Quantitative texture analysis in two-dimensional echocardiography: application to the diagnosis of experimental myocardial contusion. , 1983, Circulation.

[18]  G. Parati,et al.  Evaluation of noninvasive blood pressure monitoring devices Spacelabs 90202 and 90207 versus resting and ambulatory 24-hour intra-arterial blood pressure. , 1992, Hypertension.

[19]  E Picano,et al.  Quantitative texture analysis in two-dimensional echocardiography: application to the diagnosis of myocardial amyloidosis. , 1989, Journal of the American College of Cardiology.

[20]  R. Devereux,et al.  Left ventricular geometry, pathophysiology and prognosis. , 1995, Journal of the American College of Cardiology.

[21]  H. Vliegen,et al.  Changes in nonmyocyte tissue composition associated with pressure overload of hypertrophic human hearts. , 1989, Pathology, research and practice.

[22]  S. Shroff,et al.  Fibrillar Collagen and Myocardial Stiffness in the Intact Hypertrophied Rat Left Ventricle , 1989, Circulation research.

[23]  S. M. Collins,et al.  Detection of Acute Myocardial Infarction in Closed‐ Chest Dogs by Analysis of Regional Two‐Dimensional Echocardiographic Gray‐Level Distributions , 1983, Circulation research.

[24]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[25]  清水 玄.  Left ventricular chamber filling and midwall fiber lengthening in patients with left ventricular hypertrophy : overestimation of fiber velocities by conventional midwall measurements , 1986 .

[26]  R. Popp,et al.  Ultrasonic tissue characterization of human hypertrophied hearts in vivo with cardiac cycle-dependent variation in integrated backscatter. , 1989, Circulation.

[27]  H Feigenbaum.  Echocardiographic tissue diagnosis. , 1996, European heart journal.

[28]  S. Daniels,et al.  Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. , 1992, Journal of the American College of Cardiology.

[29]  J. G. Miller,et al.  A relationship between ultrasonic integrated backscatter and myocardial contractile function. , 1985, The Journal of clinical investigation.

[30]  J. Ren,et al.  Doppler echocardiographic evaluation of the spectrum of left ventricular diastolic dysfunction in essential hypertension. , 1994, American heart journal.

[31]  D G Gibson,et al.  Relationship between myocardial collagen and echo amplitude in non-fibrotic hearts. , 1993, European heart journal.

[32]  J. Laragh,et al.  Comparison of classification of the severity of hypertension by blood pressure level and by World Health Organization criteria in the prediction of concurrent cardiac abnormalities and subsequent complications in essential hypertension , 1993, Journal of hypertension.

[33]  B. Massie,et al.  Abnormal left ventricular filling: an early finding in mild to moderate systemic hypertension. , 1984, The American journal of cardiology.

[34]  J. Gardin,et al.  Doppler Echocardiographic Assessment of Left Ventricular Systolic and Diastolic Function in Mild Hypertension , 1987, Hypertension.

[35]  E. Sonnenblick,et al.  Stretch-induced programmed myocyte cell death. , 1995, The Journal of clinical investigation.

[36]  A. Fishman,et al.  Muscle fiber orientation and connective tissue content in the hypertrophied human heart. , 1982, Laboratory investigation; a journal of technical methods and pathology.

[37]  D. Gibson,et al.  Changes in myocardial echo amplitude during reversible ischaemia in humans. , 1992, British heart journal.

[38]  J. Gallagher,et al.  Abnormal left ventricular relaxation in hypertensive patients. , 1980, Clinical science.

[39]  N. Reichek,et al.  Alterations in diastolic function in response to progressive left ventricular hypertrophy. , 1989, Journal of the American College of Cardiology.

[40]  J. S. Janicki,et al.  Myocardial fibrosis in nonhuman primate with pressure overload hypertrophy. , 1989, The American journal of pathology.

[41]  L. Wilhelmsen,et al.  Diastolic function of the heart in untreated primary hypertension. , 1984, Hypertension.

[42]  R Hetzer,et al.  Clinical value of echocardiographic tissue characterization in the diagnosis of myocarditis. , 1996, European heart journal.

[43]  D. Mathey,et al.  Left ventricular relaxation and filling pattern in different forms of left ventricular hypertrophy: an echocardiographic study. , 1980, The American journal of cardiology.