Key result
An echocardiographic septal bulge strongly predicted clinical arterial hypertension confirmed by cycle ergometer test or ambulatory blood pressure monitoring (sensitivity 93%, specificity 86%).
Why the study?
Does an echocardiographic septal bulge predict subclinical arterial hypertension in patients without known hypertension?
Cross-Sectional (n=110)
Does an echocardiographic septal bulge predict subclinical arterial hypertension in patients without known hypertension?
Effect estimate: Sensitivity 93%, Specificity 86%
Absolute Event Rate: 79.2% vs 4.8%
An echocardiographic septal bulge is a strong morphological sign of early, subclinical hypertensive heart disease that should prompt comprehensive blood pressure evaluation.
Echocardiographic septal bulge may flag undetected hypertension; leaves open prospective validation before clinical adoption.
Patients in the early stage of hypertensive heart disease tend to have normal echocardiographic findings. The aim of this study was to investigate whether pathology-specific echocardiographic morphologic and functional parameters can help to detect subclinical hypertensive heart disease. One hundred ten consecutive patients without a history and medication for arterial hypertension (AH) or other cardiac diseases were enrolled. Standard echocardiography and two-dimensional speckle-tracking-imaging analysis were performed. Resting blood pressure (BP) measurement, cycle ergometer test (CET), and 24-hour ambulatory BP monitoring (ABPM) were conducted. Patients were referred to "septal bulge (SB)" group (basal-septal wall thickness ≥ 2 mm thicker than mid-septal wall thickness) or "no-SB" group. Echocardiographic SB was found in 48 (43.6%) of 110 patients. In this SB group, 38 (79.2%) patients showed AH either by CET or ABPM. In contrast, in the no-SB group (n = 62), 59 (95.2%) patients had no positive test for AH by CET or ABPM. When AH was solely defined by resting BP, SB was a reasonable predictive sign for AH (sensitivity 73%, specificity 76%). However, when AH was confirmed by CET or ABPM the echocardiographic SB strongly predicted clinical AH (sensitivity 93%, specificity 86%). In addition, regional myocardial deformation of the basal-septum in SB group was significantly lower than in no-SB group (14 ± 4% vs. 17 ± 4%; P < .001). In conclusion, SB is a morphologic echocardiographic sign for early hypertensive heart disease. Sophisticated BP evaluation including resting BP, ABPM, and CET should be performed in all patients with an accidental finding of a SB in echocardiography.
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Gaudron et al. (2015) conducted a cross-sectional in Hypertensive heart disease (n=110). Echocardiographic septal bulge vs. No septal bulge was evaluated on Arterial hypertension confirmed by cycle ergometer test or 24-hour ambulatory BP monitoring (Sensitivity 93%, Specificity 86%). An echocardiographic septal bulge strongly predicted clinical arterial hypertension confirmed by cycle ergometer test or ambulatory blood pressure monitoring (sensitivity 93%, specificity 86%).
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