ECHOCARDIOGRAPHY IN THE HYPERTENSIVE HEART - A NEW GRADING SYSTEM TO DEFINE THE SEVERITY OF THE STRUCTURAL AND FUNCTIONAL-CHANGES

The aim of this study is to assess the hypertensive remodeling and fun ctional changes and to form a new echocardiographic grading system tha t reflects the severity of hypertensive heart disease. We studied 213 hypertensive and 62 normotensive subjects. Grade I subjects had no lef t ventricular hypertrophy (LVH) (LVMI < 125 g/m(2)), no valvular regur gitation (VR) or stenosis (VS) with normal EF, but minimal structural changes. Grade LI patients had mild to moderate LVH (125 g/m(2) > LVMI > 170 g/m(2)) without VR or VS and normal EF; Grade III patients had LVH (LVMI > 170 g/m(2)) and/or mild to moderate VR or VS with normal E F. Grade IV changes consisted of systolic dysfunction and/or severe VR or VS with LVH. Left ventricular (LV) dimensions, LVMI of the hyperte nsive group were higher and EF lower than the normotensive subjects (p < 0.0001, p < 0.0001, p = 0.035). Mitral early filling velocities wer e not different whereas late filling velocities were higher in the hyp ertensive group. Fibrotic, calcific changes of the mitral and aortic v alves and VR were also significantly more frequent in the hypertensive group. The patients who had Grade III and IV changes were older and h ad higher blood pressures of longer duration as compared to grade I an d II subjects. LV dimensions and LVMI increased progressively in Grade I, II, III and IV patients. We can conclude that hypertension induces a wide spectrum of changes in the LV structure and function. This ech ocardiographic grading system predicts the severity of hypertensive he art disease and therefore will be helpful for risk stratification of h ypertensive patients.