tients were in New York Heart Association functional ... Key words: two-dimensional echocardiography, cardi- ... All patients were studied from a clinical-echo-.
Clin. Cardiol. 12, 91-96 (1989)
Echocardiographic Findings of Left Ventricular Hypertrophy and Normalization of Parameters of Left Ventricular Function in Patients with Previous Evidence of Dilated and Poorly Contracting Left Ventricle and Coexisting Systemic Hypertension V. DALL’AGLIO. M.D.. G . L. NICOLOSI,M.D., C. BURELLI, M.D., F. ZARDO. M . D . . D. PAVAN. M.D., C. LESTUZZI, M.D.. D. ZANUTTINI, M.D
Divisione di Cardiologia, Ospedale Civile, Pordenone, Italy
Summary: We report 6 cases of dilated left ventricle with poor left ventricular function and coexisting systemic hypertension in whom left ventricular hypertrophy and normalization of left ventricular function and dimensions have been subsequently documented by M-mode and twodimensional echocardiographic follow-up studies. Four patients were in New York Heart Association functional Class IV, one in Class 111, and one in Class I1 when first seen. Normalization of left ventricular function and dimensions and features of left ventricular hypertrophy (fractional shortening from 15.0f5.2 to 39.7i-5.4, left ventricular end-diastolic diameter from 6.6k0.6 to 4.6f0.6 cm, left ventricular end-systolic diameter from 5.6f0.8 to 2.8 k 0 . 6 c m , left ventricular end-diastolic radius/posterior wall thickness from 3.1 f0 .5 to 2.0f0.4, interventricular septum thickness from 1.2f0.3 to 1.5f0.3 cm, left atrium from 4.6f0.6 to 3.5k0.9 cm) were achieved after adequate medical treatment at the end of the follow-up (11-39 months). It appears from this study that normalization of left ventricular dimensions and function with features of left ventricular hypertrophy can occur after adequate treatment in patients with echocardiographic findings of dilated and poorly contracting left ventricle and coexisting systemic hypertension. It is conceivable, in such cases, to classify the dilatation of the left ventricle as secondary and to suggest the hypothesis
Address for reprints: Dr. Vittorio Dall’Aglio Divisione di Cardiologia Ospedale Civile “Santa Maria degli Angeli” 33 170 Pordenone, Italy Received: November 10, 1987 Accepted with revision: October 20, 1988
of a cause-effect relationship between therapy and normalization of left ventricular parameters with findings of left ventricular hypertrophy. Further studies are needed to clarify this phenomenon.
Key words: two-dimensional echocardiography, cardiomyopathy, systemic hypertension Introduction A dilated and poorly contracting left ventricle can be due to a “primary” (“idiopathic”) dilated cardiomyopathy (DCM) or can be “secondary” to a well-known cause. I - 3 When systemic hypertension is present, the dilatation of the left ventricle and the poor left ventricular (LV) function can be considered as secondary.‘-3The echocardiographic findings of DCM and of the dilated left ventricle due to systemic hypertension, however, may be similar. In our laboratory, normalization of LV dimensions and function and features of LV hypertrophy have been demonstrated by M-mode and two-dimensional echocardiographic follow-up studies in 6 cases, whose initial findings were of dilated and poorly contracting left ventricle and coexisting systemic hypertension. To our knowledge, this is the first echocardiographic documentation of normalization of left ventricular dimensions and function with findings of left ventricular hypertrophy in patients with long-standing chronic systemic hypertension and previous evidence of dilated and poorly contracting left ventricle.
Patients and Methods The study group comprises 6 patients with systemic hypertension, 4 male and 2 female, with heart failure and
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echocardiographic features of dilated and poorly contracting left ventricle. The age range was 26-64 years (mean 49). Four patients underwent echocardiographic followup after 13, 2 2 , 2 6 , and 39 months; 2 patients underwent a first echocardiographic follow-up 2 1 days and 3 months later and a second echocardiographic follow-up 11 and 15 months, respectively, after the first examination. Twodimensional echocardiograms were obtained using commercially available phased-array or mechanical sector scanners (Toshiba SSH 40A, Toshiba SSL 53M, Aloka SSD 720). Images were obtained from the parastemal, apical, and subcostal approaches to visualize cardiac chambers in the usual longitudinal, four-chamber and short-axis planes; intermediate planes were always recorded when necessary. I I Positioning and manipulation of the transducer were optimized in order to achieve adequate endocardial definition. M-mode echocardiograms were also recorded at 50 mm/s paper speed using black and white photographic paper. The following M-mode parameters were analyzed: LVFS (left ventricular fractional shortening), LVEDD (left ventricular end-diastolic diameter), LVESD (left ventricular end-systolic diameter), PWTh (posterior wall thickness), R/Th (left ventricular enddiastolic radius/posterior wall thickness), IVSTh (interventricular septum thickness), IVS%Th (percentage of IVS systolic thickening), PW%Th (percentage of PW systolic thickening), LA (left atrium dimensions). Measurements were obtained blindly by two observers according to the Recommendations of the A.S.E.12and given as the mean of the two observations. Paired r-test was used for statistical analysis. M-mode indexes of diastolic function were also studied (see Results). At the time of the first echocardiographic examination, relevant clinical data were: a history of systemic hypertension (duration of 3-7 years) was present in 4 cases. Mean blood pressure value range was 160-240 over 100-160 mmHg. Adequate therapeutic control of blood pressure had never been reached in these 4 patients. In the remaining 2 patients, it was not
possible to know when high levels of blood pressure were first observed. In these two subjects, aged 26 and 57 years, blood pressure was 230/ 160 and 180/ 1 10 mmHg, respectively, at the first examination. Four patients were in New York Heart Association (NYHA) functional Class IV, one in Class 111, and one in Class 11. There was no history of previous infective disease nor of alcohol abuse in any patient. No patient had a clinical picture of acute infective disease. All patients were studied from a clinical-echocardiographic point of view. Two patients smoked 20 cigarettes daily. In one case (CG, F, age 26), antivirus coxsackie, echo, influenza, and parainfluenza antibodies were obtained and were negative. No patient had valvular, ischemic, congenital, or specific heart muscle disease. Two patients were not treated; three patients had just started antihypertensive therapy 2, 5, and 21 days before the first echocardiogram. In one case, diuretics were started some time before without adequate blood pressure control. At the time of the last echocardiographic follow-up, relevant clinical data were: blood pressure normal in 4 patients, borderline in 2 patients. Four patients were in NYHA functional Class 11, 2 in Class I. All 6 patients were on antihypertensive treatment (captopril and diuretics in 3 cases, captopril-diuretics and verapamil in 1 case, clonidine-diuretics and nifedipine in 1 case, prazosin and diuretics in 1 case).
Results At the end of the follow-up, echocardiograms of all 6 patients showed left ventricular hypertrophy and normalization of left ventricular dimensions and function (Tables I and 11, Figs. 1-4). LVFS changed from 15.0f5.2% to 39.7,5.4% ( p < .OOOl), LVEDD from 6 . 6 f 0 . 6 to 4 . 6 k 0 . 6 cm (p
