Limited Echocardiography for Hypertensive Left Ventricular Hypertrophy
1997; Lippincott Williams & Wilkins; Volume: 29; Issue: 2 Linguagem: Inglês
10.1161/01.hyp.29.2.560
ISSN1524-4563
AutoresSheldon G. Sheps, Edward D. Fröhlich,
Tópico(s)Cardiovascular Health and Disease Prevention
ResumoHomeHypertensionVol. 29, No. 2Limited Echocardiography for Hypertensive Left Ventricular Hypertrophy Free AccessResearch ArticleDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticleDownload EPUBLimited Echocardiography for Hypertensive Left Ventricular Hypertrophy Sheldon G. Sheps and Edward D. Frohlich Sheldon G. ShepsSheldon G. Sheps Mayo Clinic, Rochester, Minn, and Ochsner Clinic, New Orleans, La. and Edward D. FrohlichEdward D. Frohlich Mayo Clinic, Rochester, Minn, and Ochsner Clinic, New Orleans, La. Originally published1 Feb 1997https://doi.org/10.1161/01.HYP.29.2.560Hypertension. 1997;29:560–563Echocardiographic assessment of left ventricular (LV) mass has provided the best noninvasive information to permit diagnostic, therapeutic, and prognostic assessment of hypertensive heart disease1234567 (Table 1). Reversal of hypertension-induced LV hypertrophy (LVH) occurs with all pharmacological (and some nonpharmacological) antihypertensive treatment, although few data are yet available to demonstrate that such reversal is associated with a reduced risk of LVH. However, one recent report suggested that patients who had changes of reversal of LVH (by electrocardiography [ECG]) were at substantially reduced risk compared with those who did not demonstrate diminished LVH.9 However, the cost of echocardiography has limited its utility in patients with hypertension. A less time-consuming and less-expensive LVH screening echocardiogram would be of great value; such a procedure is referred to as a limited echocardiogram.10TechnologyEchocardiography has been used as a standard procedure for the calculation of LV muscle mass for more than 25 years.11 Primary measurements of LV dimensions are made according to American Society of Echocardiography standards using the leading edge method of interface recognition and by identifying end diastole and end systole at the QRS onset and nadir of posterior systolic motion of the interventricular septum.121314 Adequate M-mode images for calculation of LV mass can be obtained in approximately 90% of patients in an experienced echo laboratory.151617 Assessment of the degree of LVH should include measurements of the posterior wall and septal thickness and calculation of LV mass index. However, even in patients with good-quality studies, there is significant intrareader and interreader variability of LV mass.15 For instance, in the Treatment of Mild Hypertension Study, the variance between the two readers was 23.8% (49.2g), and the intrareader variance was approximately 8.5%. Temporal variability of LV mass measurements in hypertensive patients and normotensive subjects was also highly variable.181920LVH can also be assessed by methods that are simpler or more complex than conventional echocardiography. Less complex and less expensive are ECG methods; but classic ECG criteria, although accurate when positive, are highly insensitive, identifying only 20% of patients with true LVH.212223 At the other extreme of the technology spectrum, the most precise index of LV geometry can be obtained by the three-dimensional imaging technologies. Thus, ECG-gated magnetic resonance imaging, computed tomography, and three-dimensional echocardiography also provide LV mass and volume with great precision242526 but at a higher cost and with varied availability. Patients with marked obesity and severe chronic obstructive lung disease may provide poor images, and subcostal imaging may yield a more useful study instead of the standard approach. Transesophageal echocardiography, which provides excellent cardiac images, can be used in selected circumstances for assessment of LVH, but this procedure is not recommended routinely.Recommendations for the Use of Limited EchocardiographyThe use of the limited echocardiogram for assessment of LVH risk is appropriate in untreated hypertensive patients with stage 1 blood pressure levels (systolic pressure 140 to 159 mm Hg and/or diastolic pressure 90 to 99 mm Hg) and no other evidence of LVH or other cardiovascular risk factors, and a standardized, high-quality procedure is feasible. It should not be obtained routinely in all patients with hypertension, nor should it be used for therapy selection because all classes of antihypertensive agents will diminish LV mass, providing that blood pressure is controlled. Identification of increased LV mass in an individual having hypertension of lesser stages of severity (eg, "high normal," stage 1 primarily and stage 2 rarely) is extremely valuable in helping the clinician decide whether to initiate antihypertensive drug therapy. However, in patients with stages 2 through 4 blood pressure levels (systolic pressure ≥160 mm Hg and/or diastolic pressure ≥100 mm Hg) or those with LVH and/or other cardiovascular risk factors associated with stage 1 or 2 hypertension, identification of echocardiographic evidence of increased LV mass is unnecessary because in these patients, vigorous control of pressure with antihypertensive therapy is already necessary.Follow-up limited echocardiograms in patients whose LV mass is already known is not indicated if blood pressure has not been controlled successfully. In such patients, further and more aggressive management with optimal control of pressure is clearly required. Office, ambulatory, and self blood pressure measurements (at work and home) would indicate whether blood pressure has been successfully reduced and controlled. Finally, one should not consider reduction of LV mass as a substitute for prevention of cardiovascular disease events when assessing the success of an antihypertensive agent.Indications and situations when limited echocardiography is and is not indicated are presented in Tables 2 and 3, respectively.Cost ConsiderationsWhen a more targeted approach to the management of hypertensive patients at higher risk is being considered, the availability of limited echocardiography would allow carefully selected hypertensive patients to undergo useful risk stratification, possibly without increasing the aggregate amount of financial and technical resources used. Although some younger patients with hypertension may be undergoing a more comprehensive echocardiographic procedure for other specific clinical indications, it may be more appropriate and cost-effective to obtain limited echocardiograms for these younger patients when the primary clinical issue is assessment of LVH.One recent report indicated that in asymptomatic patients with hypertension and a normal clinical cardiac examination, a limited echocardiographic study rarely misses significant LVH.17 Moreover, any further clinically relevant information would be provided by a more comprehensive echocardiographic study in less than 10% of patients.17 When the expense of long-term antihypertensive drug therapy, especially for newer drugs, is being considered, it may be more cost conserving to use limited echocardiography as part of a screening strategy for initiating antihypertensive drug treatment.2728The more comprehensive and costly M-mode, 2-D, and Doppler echocardiographic evaluations may be warranted in the following patients: (1) hypertensive patients with chest pain, unexplained dyspnea, or other cardiac symptoms to assess LV systolic or diastolic function; (2) patients with systolic or diastolic murmurs to help define their cause or significance; and (3) patients with comorbid cardiac problems. More comprehensive echocardiographic examination may also be of value in distinguishing physiological from pathological hypertrophy in athletes.Economic Information About Limited EchocardiographyThe Medicare claims data analyzed initially by the American Medical Association for 1992 through 1994 were reviewed and the following noted: (1) The volume of 2-D, M-mode echocardiograms (CPT code 93307) increased over that period from 3 191 922 to 3 596 686; (2) the volume of limited echocardiograms (CPT code 93308) declined for the same period from 53 131 to 43 110 (Figure); (3) in 1994, essential hypertension was one of the top eight diagnostic codes listed on claims that included 2-D, M-mode echocardiography (CPT code 93307), and 7% of the claims for that procedure had an associated diagnosis of essential hypertension (ICD-6 code 401); and (4) on a line-item basis for echocardiography performed in 1994, essential hypertension was listed as one of the top eight diagnostic codes, representing 4% of the diagnoses identified as justifying this procedure (these data are consistent with limited echocardiographic Medicare data from 1986 to 1993).The foregoing data, although interesting, must be cautiously interpreted before any conclusions are drawn regarding the actual current use of limited and/or 2-D, M-mode echocardiography for the evaluation of hypertensive LVH. Since justification for this procedure may have been considered disallowable, an alternative diagnosis may have been selected. Other potentially useful data sets (eg, the Uniform Hospital Discharge Data Set, or UHDDS) have not been evaluated to delineate further the precise utilization of these procedures in the overall hypertensive population and to support or refute the Medicare claims data findings. The only known and available data are presented in this report.Medicare has two data files that have been of particular value. The American College of Cardiology has analyzed the 1986-1993 Medicare procedure files, which include 100% of actual claims (submitted by physicians through the Part B Medicare Annual Data (BMAD) files) (Table 4). In addition, the Medicare beneficiary file has proved useful. The latter file consists of a 5% longitudinal sampling of all beneficiaries capturing code ICD-9 diagnostic aligned with each procedure code; this is required by the Health Care Financing Administration as a means of justifying the procedure. The CPT codes used to identify echocardiographic services have been in a state of flux for years and have undergone coding changes. Before 1990, two coding systems existed, one for radiology (70000 series) and the other for cardiology (93300 series). At the same time, evolution of the technology led to consolidation of the codes (2-D, M-mode, etc). These issues have obviously complicated the data.Possible explanations for the reduction in the frequency of utilization of limited echocardiograms during the later period include: (1) A general awareness developed that a more limited procedure was not broadly appreciated by the physicians interested in the study; (2) greater third-party reimbursement was available by ordering 2-D, M-mode, and Doppler echocardiograms; and (3) with the broadened interest of physicians in hypertensive heart disease, those who were concerned about that problem may have ordered the more costly procedure without considering a less-expensive alternative. This possibility seems likely, especially when one considers that the concept of limited echocardiography had not been recommended broadly in peer-reviewed cardiovascular journal articles.In conclusion, echocardiography is a safe, sensitive, and accurate tool for assessment of cardiac function in patients with hypertension. Despite some limitations, the determination of LV mass by echocardiography is a powerful predictor of cardiovascular risk. Limited echocardiography has been used less frequently in recent years. A limited echocardiogram for the detection of increased LV mass in carefully selected hypertensive patients would be appropriate in a targeted approach to the detection of patients at increased risk as part of a program to reduce their morbidity and mortality by the use of antihypertensive medications in addition to lifestyle changes. The overall effect could be a reduction in the cost of the lifetime management of hypertension in those selected patients.Download figureDownload PowerPoint Figure 1. Annual volumes of limited echocardiographic procedures from Medicare data. Table 1. Summary of Epidemiological Studies Relating Echocardiographic Left Ventricular Mass With Long-term PrognosisReferenceType of Cohort (n)Follow-upEnd-point EventsTotalRelative Risk with LVHLevy et al2GP (1911)4 yearsCAD70Men: 1.67*Women: 1.60*Levy et al3GP (3220)4 yearsCVD208Men: 1.49†Women: 1.57†All deaths124Men: 1.73†Women: 2.12†Casale et al5HTN (140)4.8 yearsCVD14Men: 3.83Koren et al6HTN (280)10.2 yearsCVD40All: 2.17CVD death11All: 14.00All deaths19All: 3.50Ghali et al7HTN, mostly black, had angio (785)4 yearsCardiac deathNACAD: 2.73‡No CAD: 2.80‡All death80CAD: 2:14‡No CAD: 4.14‡LVH indicates echocardiographic left ventricular hypertrophy; GP, general population; CAD, coronary artery disease; CVD, cardiovascular disease; HTN, hypertensive; and angio, coronary angiography. Table and references from Lauer8 with permission.*Relative risks for each increment of 50 g/m of left ventricular mass after adjusting for age, systolic pressure, smoking, and ratio of total to high-density lipoprotein cholesterol.†Relative risks for each increment of 50 g/m left ventricular mass after adjusting for age, blood pressure, antihypertensive treatment, ratio of total to high-density lipoprotein cholesterol, number of cigarettes smoked per day, diabetes, body mass index, and electrocardiographic LVH.‡Adjusted for age, sex, and hypertension. Table 2. Indications For Limited Echocardiography• Untreated hypertensive patients with stage 1 blood pressure levels (140-159/90-99 mm Hg), having no other evidence of LVH or no other cardiovascular risk factors.• When evidence of LVH requires further clarification (eg, suspected false positive electrocardiographic voltage changes, electrocardiograph with left atrial abnormality).• To minimize overuse of more costly echocardiographic procedures when only left ventricular mass and wall thickness measurements are desired. Table 3. Situations In Which Limited Echocardiography Is Not Indicated• Not a routine procedure for all patients with hypertension.• Untreated hypertensive patients with stage 1 blood pressure levels (140-159/90-99 mm Hg) having electrocardiographic evidence of left ventricular hypertrophy or other cardiovascular risk factors. These patients should be treated vigorously to achieve effective control of pressure.• To select antihypertensive therapy.• Patients with stages 2 through 4 blood pressure levels (>160/<100 mm Hg) with left ventricular hypertrophy (or other risk factors).• For follow-up once increased left ventricular mass is established. Table 4. Echo Trend Data 1986-1993: Volume Only, Includes Coding ChangesCodeDescription1986198719881989199019911992199393300*2D131 004130 658123 56855 11316 6908737076620*2D137 015124 97766 06425 38718922071093307M-mode212 724257 874253 459876 9911 546 9161 920 3432 218 0492 410 97376627*M-mode165 877164 01799 34541 6531585870093309*2D/M-mode196 897287 761489 519238 46054 716136914076629*2D/M-mode51 56194 152193 94160 54818397500Total895 0781 059 4391 225 8961 298 1521 623 6381 922 9542 218 0712 410 973Change18%16%6%25%18%15%9%Follow-up93305*2D22 42499438561370073528010076625*2D652129641833257111200933082D/M-mode24 80817 78920 77026 20454 38846 35335 76135 51276628*2D/M-mode68282589288836028900Total60 58133 28534 05230 52155 16246 65435 77135 512Change−45%2%−10%81%−15%−23%−1%Source: Medicare claims data, 1986-1993. Percent change 1987-1993: complete echo, 126%; limited echo, 7%.*Codes deleted in 1990.The authors gratefully acknowledge guidance from Drs Henry R. Black, Richard E. Devereux, Tonette Krousel-Wood, Daniel Levy, Philip R. Liebson, Barry M. Massie, Franz H. Messerli, Jack P. Segal, Clarence Shub, and James V. Talano. Each individual is an eminent authority in one or more of the following fields: cardiovascular medicine, hypertensive diseases, echocardiography, cardiovascular epidemiology, or healthcare analysis.FootnotesCorrespondence to Sheldon G. Sheps, MD, Division of Hypertension, Mayo Clinic, West 9, 200 First St SW, Rochester, MN 55905. E-mail [email protected] References 1 Frohlich ED, Apstein C, Chobanian AV, Devereux RB, Dustan HP, Dzau V, Fauad-Tarazi F, Horan MJ, Marcus M, Massie B, Pfeffer MA, Re RN, Roccella EJ, Savage D, Shub C. The heart in hypertension. N Engl J Med.1992; 327:998-1008.CrossrefMedlineGoogle Scholar2 Levy D, Garrison RI, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med.1990; 322:1561-1566.CrossrefMedlineGoogle Scholar3 Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Left ventricular mass and incidence of coronary heart disease in an elderly cohort: the Framingham Heart Study. Ann Intern Med.1989; 110:101-107.CrossrefMedlineGoogle Scholar4 Bikina M, Evans JC, Larson MG, Benjamin EJ, Levy D. Left ventricular mass and risk of stroke in a elderly cohort: The Framingham Heart Study. JAMA.1994; 272:33-36.CrossrefMedlineGoogle Scholar5 Casale PN, Devereux RB, Milner M, Zullo G, Harshfield GA, Pickering TG, Laragh JH. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med.1986; 105:173-178.CrossrefMedlineGoogle Scholar6 Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and mortality in uncomplicated essential hypertension. Ann Intern Med.1991; 114:345-352.CrossrefMedlineGoogle Scholar7 Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS. The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease. Ann Intern Med.1992; 117:831-836.CrossrefMedlineGoogle Scholar8 Lauer MS. Left ventricular hypertrophy and cardiovascular prognosis. Cleve Clin J Med.1995; 62:169-175.CrossrefMedlineGoogle Scholar9 Levy D, Salomon M, D'Agostino RB, Belanger AJ, Kannel WB. Prognostic implications of baseline electrocardiographic features and their serial changes in subject with left ventricular hypertrophy. Circulation.1994; 90:1786-1793.CrossrefMedlineGoogle Scholar10 Black HR, Weltin G, Jaffe CC. The limited echocardiogram: a modification of standard echocardiography for use in the routine evaluation of patients with systemic hypertension. Am J Cardiol.1991; 67:1027-1030.CrossrefMedlineGoogle Scholar11 Devereux RB, Liebson PR, Horan MJ. Recommendations concerning the use of echocardiography in hypertension and general population research. Hypertension. 1987;9(suppl II):II-97-II-104.Google Scholar12 Devereux RB, Roman MJ. Evaluation of cardiac and vascular structure by echocardiography and other noninvasive techniques. In: Laragh JH, Brenner BM, eds. Hypertension: Pathophysiology, Diagnosis, Management. 2nd ed. New York, NY: Raven Press Publishers; 1995:1969-1985.Google Scholar13 Sahn DJ, DeMaria A, Kisslo J, Weyman A. The Committee on M-mode Standardization of the American Society of Echocardiography: recommendations regarding measurements. Circulation.1978; 58:1072-1083.CrossrefMedlineGoogle Scholar14 Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Shah D, Schnittger I, Silverman NH, Tajik AJ. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiogram: recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr.1989; 2:358-367.CrossrefMedlineGoogle Scholar15 Liebson PR, Grandits G, Prance R, Dianzumba S, Flack JM, Cutler JA, Grimm R, Stamler J. Echocardiographic correlates of left ventricular structure among 844 mildly hypertensive men and women in the Treatment of Mild Hypertension Study (TOMHS). Circulation.1993; 87:476-486.CrossrefMedlineGoogle Scholar16 Shub C, Klein AL, Zachariah PK, Baily KR, Tajik AJ. Determination of left ventricular mass by echocardiography in a normal population: effect of age and sex in addition to body size. Mayo Clin Proc.1994; 69:205-211.CrossrefMedlineGoogle Scholar17 Shub C, Tajik AJ, Sheps SG. Value of two-dimensional echocardiography and Doppler examination in the assessment of hypertensive patients: a pilot study. J Am Soc Echocardiogr.1995; 8:280-284.CrossrefMedlineGoogle Scholar18 Gottdiener JS, Livengood SV, Meyers PS, Chase GA. Should echocardiography be performed to assess effets of antihypertensive therapy? Test-retest reliability of edhocardiography for measurement of left ventricular for measurement of left ventricular mass and function. J Amer Col Cardiol. 1995;25:424-430.Google Scholar19 Wallerson DC, Devereux RB. Reproducibility of echocardiographic left ventricular measurements. Hypertension. 1987;9(suppl II):II-6-II-18.Google Scholar20 de Simone G, Ganau A, Verdecchia P, Devereux RB. Echocardiography in arterial hypertension: when, why and how. J Hypertens.1994; 12:1129-1136.MedlineGoogle Scholar21 Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer electrocardiogram interpretation: validation with autopsy findings. Circulation.1987; 75:565-572.CrossrefMedlineGoogle Scholar22 Norman JE, Levy D, Campbell G, Bailey JJ. Improved detection of echocardiographic left ventricular hypertrophy using a new electrocardiographic algorithm. J Am Coll Cardiol.1993; 21:1680-1688.CrossrefMedlineGoogle Scholar23 Molloy T, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol.1992; 20:1180-1186.CrossrefMedlineGoogle Scholar24 Feiring AJ, Rumberger JA, Reiter SJ, Skorton DJ, Collens SM, Lipton MJ, Higgins CB, Ell S, Marcus ML. Determination of left ventricular mass in dogs with rapid-acquisition cardiac computed tomographic scanning. Circulation.1985; 72:1355-1364.CrossrefMedlineGoogle Scholar25 Keller AM, Peshock RM, Malloy CR, Buja LM, Nunnally R, Parkey RW, Willerson JT. In vivo measurement of myocardial mass using nuclear magnetic resonance imaging. J Am Coll Cardiol.1986; 8:113-117.CrossrefMedlineGoogle Scholar26 Gopal AS, Keller AM, Shen Z, Sapin PM, Schroeder KM, King DL Jr, King DL. Three dimensional echo: in vitro and in vivo validation of LV mass and comparison with conventional echocardiographic methods. J Am Coll Cardiol.1994; 24:504-513.CrossrefMedlineGoogle Scholar27 Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The 1992 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V). Arch Intern Med.1993; 153:154-183.CrossrefMedlineGoogle Scholar28 Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, Horan MJ, Labarthe D. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension.1995; 25:305-313.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Wang M and Lloyd-Jones D (2021) Cardiovascular Risk Assessment in Hypertensive Patients, American Journal of Hypertension, 10.1093/ajh/hpab021, 34:6, (569-577), Online publication date: 22-Jun-2021. Kobayashi T and Kato H (2016) Development of Pocket-sized Hand-held Ultrasound Devices Enhancing People's Abilities and Need for Education on Them, Journal of General and Family Medicine, 10.14442/jgfm.17.4_276, 17:4, (276-288), Online publication date: 1-Dec-2016. Varis J, Puukka P, Karanko H and Jula A (2013) Risk assessment of echocardiographic left ventricular hypertrophy with electrocardiography, body mass index and blood pressure, Blood Pressure, 10.3109/08037051.2013.803313, 23:1, (39-46), Online publication date: 1-Feb-2014. Borrione P (2013) Pre-participation screening for the prevention of sudden cardiac death in athletes, World Journal of Methodology, 10.5662/wjm.v3.i1.1, 3:1, (1), . Lee S, Cowan P, Yoo W and Wetzel G (2013) Determining Left Ventricular Hypertrophy in Overweight-Obese Youth Using Electrocardiogram Criteria, Journal of Nursing Measurement, 10.1891/1061-3749.21.2.178, 21:2, (178-187), . Kapur G and Baracco R (2013) Evaluation of Hypertension in Children, Current Hypertension Reports, 10.1007/s11906-013-0371-2, 15:5, (433-443), Online publication date: 1-Oct-2013. Leese P, Viera A, Hinderliter A and Stearns S (2010) Cost-Effectiveness of Electrocardiography vs. Electrocardiography Plus Limited Echocardiography to Diagnose LVH in Young, Newly Identified, Hypertensives, American Journal of Hypertension, 10.1038/ajh.2010.42, 23:6, (592-598), Online publication date: 1-Jun-2010. Sampson U and Mensah G (2010) Initial Clinical Encounter with the Patient with Established Hypertension, Cardiology Clinics, 10.1016/j.ccl.2010.08.003, 28:4, (587-595), Online publication date: 1-Nov-2010. de Simone G, Chinali M, Galderisi M, Benincasa M, Girfoglio D, Botta I, D'Addeo G and de Divitiis O (2009) Myocardial mechano-energetic efficiency in hypertensive adults, Journal of Hypertension, 10.1097/HJH.0b013e328320ab97, 27:3, (650-655), Online publication date: 1-Mar-2009. GOLDMAN M and CROFT L (2007) Hand-Carried Ultrasound The Practice of Clinical Echocardiography, 10.1016/B978-1-4160-3640-1.50012-5, (172-183), . Ferrario C, Basile J, Bestermann W, Frohlich E, Houston M, Lackland D, Smith R and Wise D (2016) Review: The role of noninvasive hemodynamic monitoring in the evaluation and treatment of hypertension, Therapeutic Advances in Cardiovascular Disease, 10.1177/1753944707086095, 1:2, (113-118), Online publication date: 1-Dec-2007. Lee D, Wang T and Ramachandran V (2006) Screening for ventricular remodeling, Current Heart Failure Reports, 10.1007/s11897-006-0025-7, 3:1, (5-13), Online publication date: 1-Apr-2006. Manasia A, Nagaraj H, Kodali R, Croft L, Oropello J, Kohli-Seth R, Leibowitz A, DelGiudice R, Hufanda J, Benjamin E and Goldman M (2005) Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients, Journal of Cardiothoracic and Vascular Anesthesia, 10.1053/j.jvca.2005.01.023, 19:2, (155-159), Online publication date: 1-Apr-2005. Roelandt J (2004) Ultrasound stethoscopy, European Journal of Internal Medicine, 10.1016/j.ejim.2004.08.002, 15:6, (337-347), Online publication date: 1-Oct-2004. Senior R, Galasko G, Hickman M, Jeetley P and Lahiri A (2004) Community screening for left ventricular hypertrophy in patients with hypertension using hand-held echocardiography, Journal of the American Society of Echocardiography, 10.1016/j.echo.2003.09.013, 17:1, (56-61), Online publication date: 1-Jan-2004. Waggoner A (2016) Echocardiographic Assessment of Left Ventricular Structure in Hypertension and the Impact on Clinical Outcomes, Journal of Diagnostic Medical Sonography, 10.1177/8756479304268200, 20:5, (304-314), Online publication date: 1-Sep-2004. Alexander J, Peterson E, Chen A, Harding T, Adams D and Kisslo J (2004) Feasibility of point-of-care echocardiography by internal medicine house staff, American Heart Journal, 10.1016/j.ahj.2003.10.010, 147:3, (476-481), Online publication date: 1-Mar-2004. Gaur A, Yeon S, Lewis C and Manning W (2003) Valvular flow abnormalities are often identified by a resting focused Doppler examination performed at the time of stress echocardiography, The American Journal of Medicine, 10.1016/S0002-9343(02)01381-5, 114:1, (20-24), Online publication date: 1-Jan-2003. Kimura B and DeMaria A (2003) Time requirements of the standard echocardiogram: implications regarding limited studies, Journal of the American Society of Echocardiography, 10.1016/S0894-7317(03)00590-X, 16:10, (1015-1018), Online publication date: 1-Oct-2003. Kimura B, Blanchard D, Willis C and DeMaria A (2002) Limited cardiac ultrasound examination for cost-effective echocardiographic referral, Journal of the American Society of Echocardiography, 10.1067/mje.2002.117628, 15:6, (640-646), Online publication date: 1-Jun-2002. Vourvouri E, Poldermans D, De Sutter J, Sozzi F, Izzo P and Roelandt J (2002) Experience with an ultrasound stethoscope, Journal of the American Society of Echocardiography, 10.1067/mje.2002.115268, 15:1, (80-85), Online publication date: 1-Jan-2002. FROHLICH E (2002) Clinical Management of the Obese Hypertensive Patient, Cardiology in Review, 10.1097/00045415-200205000-00001, 10:3, (127-138), Online publication date: 1-May-2002. Slama M, Susic D, Varagic J and Frohlich E (2002) Diastolic dysfunction in hypertension, Current Opinion in Cardiology, 10.1097/00001573-200207000-00008, 17:4, (368-373), Online publication date: 1-Jul-2002. Townsend R (2001) How Often Should "Surveillance EKGs" Be Obtained in the Follow-up of Asymptomatic Hypertensives?, The Journal of Clinical Hypertension, 10.1111/j.1524-6175.2001.00454.x, 3:2, (119-119), Online publication date: 1-Mar-2001. Kimura B, Bocchicchio M, Willis C and DeMaria A (2001) Screening cardiac ultrasonographic examination in patients with suspected cardiac disease in the emergency department, American Heart Journal, 10.1067/mhj.2001.116475, 142:2, (324-330), Online publication date: 1-Aug-2001. Kimura B and DeMaria A (2000) Indications for limited echocardiographic imaging: A mathematical model, Journal of the American Society of Echocardiography, 10.1067/mje.2000.106730, 13:9, (855-861), Online publication date: 1-Sep-2000. Mensah G (2007) The Role of Echocardiography in Hypertensive Heart Disease in the Elderly, The American Journal of Geriatric Cardiology, 10.1111/j.1076-7460.2000.80063.x, 9:6, (330-341), Online publication date: 1-Nov-2000. Vasan R, Levy D, Larson M and Benjamin E (2000) Interpretation of echocardiographic measurements: A call for standardization, American Heart Journal, 10.1016/S0002-8703(00)90084-X, 139:3, (412-422), Online publication date: 1-Mar-2000. Bruce C, Spittell P, Montgomery S, Bailey K, Tajik A and Seward J (2000) Personal Ultrasound Imager: Abdominal Aortic Aneurysm Screening, Journal of the American Society of Echocardiography, 10.1067/mje.2000.107797, 13:7, (674-679), Online publication date: 1-Jul-2000. Abergel E, Chatellier G, Battaglia C and Menard J (1999) Can echocardiography identify mildly hypertensive patients at high risk, left untreated based on current guidelines?, Journal of Hypertension, 10.1097/00004872-199917060-00014, 17:6, (817-824), Online publication date: 1-Jun-1999. BENJAMIN E and LEVY D (1999) Why Is Left Ventricular Hypertrophy So Predictive of Morbidity and Mortality?, The American Journal of the Medical Sciences, 10.1097/00000441-199903000-00006, 317:3, (168-175), Online publication date: 1-Mar-1999. HALL W (1999) Abnormalities of Kidney Function as a Cause and a Consequence of Cardiovascular Disease, The American Journal of the Medical Sciences, 10.1097/00000441-199903000-00007, 317:3, (176-182), Online publication date: 1-Mar-1999. Benjamin E and Levy D (1999) Why Is Left Ventricular Hypertrophy So Predictive of Morbidity and Mortality?, The American Journal of the Medical Sciences, 10.1016/S0002-9629(15)40499-9, 317:3, (168-175), Online publication date: 1-Mar-1999. de Simone G, Muiesan M, Ganau A, Longhini C, Verdecchia P, Palmieri V, Agabiti-Rosei E and Mancia G (1999) Reliability and limitations of echocardiographic measurement of left ventricular mass for risk stratification and follow-up in single patients, Journal of Hypertension, 10.1097/00004872-199917121-00027, 17:Supplement, (1955-1963), Online publication date: 1-Dec-1999. Dallas Hall W (1999) Abnormalities of Kidney Function as a Cause and a Consequence of Cardiovascular Disease, The American Journal of the Medical Sciences, 10.1016/S0002-9629(15)40500-2, 317:3, (176-182), Online publication date: 1-Mar-1999. Olutade B and Dallas Hall W (1997) Systolic hypertension in the elderly, Current Problems in Cardiology, 10.1016/S0146-2806(97)80010-2, 22:8, (405-448), Online publication date: 1-Aug-1997. Frohlich E (1997) CURRENT CLINICAL PATHOPHYSIOLOGIC CONSIDERATIONS IN ESSENTIAL HYPERTENSION, Medical Clinics of North America, 10.1016/S0025-7125(05)70570-8, 81:5, (1113-1129), Online publication date: 1-Sep-1997. February 1997Vol 29, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/01.HYP.29.2.560 Manuscript receivedJune 11, 1996Originally publishedFebruary 1, 1997Manuscript revisedJuly 8, 1996 Keywordshypertrophy, left ventricularechocardiographytechnology assessment, biomedical Advertisement
Referência(s)