The detection of left ventricular hypertrophy and diastolic dysfunction

Abstract

All guidelines for the diagnosis and management of hypertension recommend that electrocardiographic (ECG) evidence of left ventricular hypertrophy (LVH) is sought for accurate risk assessment. The presence of ECG patterns that fulfill the criteria for LVH suggest a > 20% absolute 10-year risk of developing cardiovascular disease, and is a compelling indication for the use of antihypertensives that block the renin angiotensin system.¹ Many guidelines also suggest that an echocardiogram is performed to confirm or refute the presence of LVH suggested by ECG criteria. However, in South Africa, access to echocardiography is costly and limited. However, echocardiography may be a critically important tool in the care of the hypertensive patient with LVH who presents with dyspnoea, when the cause is not obvious. These patients may have heart failure caused by diastolic dysfunction. A major cardiovascular consequence of LVH in hypertension is progression to heart failure, in part through the effects on diastolic, rather than systolic (pump), function.2 In these cases, the LV develops an inability to relax adequately, or a reduced compliance (increased stiffness) occurs. Consequently, this increases filling pressures in the left ventricle (LV) and left atrium (LA). These patients have heart failure with a preserved pump function, as indexed by a normal ejection fraction (EF) HFpEF). In contrast to patients with heart failure with a reduced EF (HFrEF) who have an attenuated pump function that is easily detected by using a number of approaches, the presence of HFpEF often poses a considerable diagnostic challenge.