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This study examined 1,559 patients with hypertensive heart disease and found that apical sparing of left ventricular strain, typically associated with cardiac amyloidosis, occurred in less than 1% of hypertensive patients but was completely reversible with blood pressure treatment. The researchers demonstrated that this transient apical sparing pattern in hypertension is mechanistically linked to regional wall stress according to Laplace's law, unlike the persistent apical sparing seen in amyloidosis which is caused by protein deposition. After antihypertensive treatment, all 14 hypertensive patients with initial apical sparing showed resolution of this pattern, with improved strain measurements in the basal and midventricular regions.
Why it matters
This finding helps cardiologists differentiate between hypertensive heart disease and cardiac amyloidosis when apical sparing is detected on echocardiography, potentially reducing misdiagnosis. The reversibility of apical sparing with blood pressure control in hypertensive patients provides both a diagnostic clue and evidence that adequate treatment can normalize cardiac mechanical function.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Apical sparing of left ventricular longitudinal strain (LS) is an echocardiographic clue to cardiac amyloidosis but may also occur in hypertensive heart disease (HHD). Objectives: To determine whether apical sparing in HHD is associated with regional left ventricular wall stress estimated according to Laplace’s law. Methods: We retrospectively studied 1,559 patients with HHD, 47 with light-chain cardiac amyloidosis (ALCA), and 409 normotensive controls. Artificial intelligence-assisted echocardiography quantified segmental LS, wall thickness, and cavity radius at the basal, midventricular, and apical levels. Wall stress was estimated as mean blood pressure (MBP) x radius/(2 x wall thickness). Apical sparing was defined as a relative regional strain ratio (RRSR)[≥]1.0. Results: Apical sparing was present in 14 patients with HHD (0.9%), 13 with ALCA (27.7%), and no controls. Among HHD patients with apical sparing, RRSR decreased from 1.11{+/-}0.13 to 0.72{+/-}0.10 after antihypertensive treatment (P<0.001), accompanied by reduced wall stress and improved basal and midventricular LS, with resolution of apical sparing in all 14 patients. In the overall HHD cohort, changes in MBP and left ventricular mass index were independently associated with changes in RRSR. In an exploratory analysis of HHD patients with apical sparing, a reduction in basal wall stress was associated with a reduction in RRSR ({beta}=0.267 for {bigtriangleup}RRSRx100, 95% CI 0.023-0.511; P=0.036). In ALCA, favorable hematologic response was the only determinant of RRSR reduction. Conclusions: Apical sparing in HHD was uncommon but reversible and may represent a load-sensitive deformation pattern associated with regional wall stress, consistent with Laplace's law.
Source: Transient Apical Sparing in Hypertensive Heart Disease Explained by Laplace's Law