Abstract 12688: Left Ventricular Hypertrophy in Hypertensive Patients: A Reliable Diagnosis?
Background: Hypertensive patients with left ventricular hypertrophy (LVH), typically assessed by 2D echo, are at a greater risk for heart failure and sudden cardiac death. An accurate diagnosis of LVH in hypertensive patients is essential to clinical evaluation and treatment. However, 2D echo has inferior spatial resolution and less than optimal measurement positioning, relative to cardiac MRI(cMRI). This “real-world” study, based on finalized 2D echo reports, sought to compare assessment of LVH on 2D echo to results by cMRI, in a cohort of patients with a diagnosis of hypertension(HTN).
Methods: All 1,341 patients in a multi-institutional cardiac MRI database were queried for a diagnosis of HTN. Those hypertensive patients with a 2D echo study within 6 months of the cMRI study constituted the study cohort. Patient 2D and cMRI reports were then classified as either Negative (no evidence of LVH on the final report) or Positive (evidence of LVH on the final report). Antero-septal and infero-posterior LV wall thickness dimensions were recorded for both imaging modalities for all hypertensive patients A paired-sample t-test was used for statistical comparison.
Results: 411 patients in the cMRI database with a diagnosis of HTN had both 2D echo and cMRI exams. Of these 411 patients, 213 patients had a diagnosis of LVH on the 2D echo report. On 2D echo the mean antero-septal LV wall thickness was 1.24 ± 0.24 cm, while on cMRI the mean antero-septal LV wall thickness was 1.15 ± 0.32 cm (p≤0.001). On 2D echo the mean infero-posterior LV wall thickness was 1.22 ± 0.22 cm, while comparatively the mean infero-posterior LV wall thickness by cMRI was 0.92 ± 0.24 cm (p≤0.001). Of the 213 hypertensive patients with a diagnosis of LVH on the 2D echo report, the diagnosis of LVH was corroborated by cMRI in 120 cases(56.3%).
Conclusions: Among hypertensive patients, there is low concordance between 2D echo and cMRI for a diagnosis of LVH, as derived from final imaging reports in active clinical practices. Because of better spatial resolution, less restricted viewing window and more accurate positioning of LV wall thickness dimensions, cMRI may be an appropriate imaging modality for assessing left ventricular hypertrophy among hypertensive patients to minimize overdiagnosis.
- © 2013 by American Heart Association, Inc.