AUTHOR=Lange Aleksandra , Palka Viktoria , Bian Chris , Huntress Harry , Morgan Jill , Allwood Sean , Swann Rohan , Palka Przemysław 

TITLE=Left heart remodelling in hypertensive patients: a comprehensive echocardiography and computed tomography study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1295537

DOI=10.3389/fcvm.2023.1295537

ISSN=2297-055X

ABSTRACT=<sec><title>Objectives</title><p>This study aimed to assess left heart remodelling changes in hypertension, excluding underlying ischaemic heart disease, utilising computed tomography coronary angiography (CTCA) and transthoracic echocardiography (TTE).</p></sec><sec><title>Methods</title><p>A total of 178 patients (mean age 60 ± 9 years, 53% female) were enrolled in the study: Group 1 consisted of patients with essential hypertension (<italic>n</italic> = 96, Group 1), and Group 2 served as age-matched controls (<italic>n</italic> = 82, Group 2). All participants underwent both CTCA and TTE. TTE measurements included left ventricle (LV) concentricity and function and left atrial (LA) volume and function. Using both CTCA and TTE, we measured LV diastasis volume (LV<sub>dias</sub>) and LA diastasis volume (LA<sub>dias</sub>).</p></sec><sec><title>Results</title><p>LV mass index and LV mass/height<sup>2.7</sup> were similar in both the groups. However, Group 1 had a higher prevalence of concentric LV remodelling, characterised by a larger mean LV wall thickness, increased relative wall thickness ratio, and a reduced ratio of LV end-diastolic volume (LV<sub>ED</sub>) index to mean wall thickness (55 ± 14 vs. 65 ± 15, <italic>p</italic> = 0.0007). Group 1 showed higher LA<sub>dias</sub> and LA minimal volumes, while LA reservoir function was lower in Group 2. The LV<sub>dias</sub>/LA<sub>dias</sub> ratio was lower in Group 1 compared to Group 2 (TTE 1.77 ± 0.61 vs. 2.24 ± 1.24, <italic>p</italic> = 0.0025, CTCA 1.50 ± 0.23 vs. 1.69 ± 0.41, <italic>p</italic> = 0.0002). A composite score based on four combined TTE parameters, namely, LV<sub>ED</sub> index/mean wall thickness ≤57, ratio of early diastolic mitral inflow to mitral annular tissue velocities (E/e’) &gt;8, LV<sub>dias</sub>/LA<sub>dias</sub> ≤1.62, and LA reservoir function ≤0.58, yielded the highest discriminatory power (area under the curve—AUC = 0.772) for distinguishing patients with hypertensive heart disease (HHD). Collectively, we refer to these parameters as the LEDA score, with each parameter scored as one point. For LEDA scores of 0, 1, 2, 3, 4, the probability of underlying HHD was 0%, 23%, 59%, 80%, and 95%, respectively. Furthermore, a CTCA-derived LV<sub>dias</sub>/LA<sub>dias</sub> ≤1.76, considered as a single parameter, demonstrated modest accuracy in differentiating patients with HHD (AUC = 0.646).</p></sec><sec><title>Conclusions</title><p>The TTE LEDA score, based on four parameters, namely, LV<sub>ED</sub> index/mean wall thickness, E/e’, LV<sub>dias</sub>/LA<sub>dias</sub>, and LA reservoir function, proved to be the most effective in defining left heart remodelling in hypertension.</p></sec>