Published Online
on December 16, 2002

A more recent version of this article appeared on January 7, 2003

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Submitted on July 19, 2002
Revised on September 17, 2002
Accepted on September 23, 2002

Incremental Value of Ultrasonic Tissue Characterization (Backscatter) in the Evaluation of Left Ventricular Myocardial Structure and Mechanics in Essential Arterial Hypertension

Vitantonio Di Bello MD^*, Davide Giorgi MD, Enrica Talini MD, Giulia Dell' Omo MD, Caterina Palagi MD, Maria Francesca Romano PhD, Roberto Pedrinelli MD, and Mario Mariani MD

From the Cardiac and Thoracic Department, University of Pisa (V.D.B., D.G., E.T., G.D.O., C.P., R.P., M.M.), and Sant'Anna School of Advanced Studies (M.F.R.), Pisa, Italy.

^* To whom correspondence should be addressed. E-mail: dibellov{at}ifc.cnr.it.

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]).

Methods and 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.

Key words: ultrasonics • hypertension • hypertrophy • echocardiography

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