Transthoracic Echocardiography for Evaluation of Hypertensive Heart Disease

Systemic arterial hypertension is a common malady in the United States, with as many as 58 million persons having a diagnosis of hypertension. Left ventricular hypertrophy (LVH), which develops as a response to the elevated afterload, may be viewed as necessary and protective. However, many recent studies have demonstrated that significant abnormalities of the coronary circulation occur with LVH. These include impaired vasodilator reserve, altered autoregulation, increased tendency to ventricular arrhythmias, and increased infarct size. In addition, adverse effects directly on cardiac muscle which includes decreased contractility, and altered diastolic function may also be present. Therefore, the presence or absence of LVH may predict outcome in addition to hypertension alone. In this review I will discuss potential advantages and disadvantages of each transthoracic echocardiographic method of measuring LV mass. I will also discuss the controversy surrounding serial measurements of LV mass with antihypertensive therapies.