Association of Hypertensive Intracerebral Hemorrhage with Left Ventricular Hypertrophy on Transthoracic Echocardiography

Abstract

<jats:p>Introduction: Arterial hypertension is the most frequent cause for spontaneous intracerebral hemorrhage (sICH) and may also cause left ventricular hypertrophy (LVH). We sought to analyze whether hypertensive sICH etiology is associated with LVH. Methods: We analyzed consecutive patients with sICH who were admitted to our tertiary stroke center during a four-year period and underwent transthoracic echocardiography (TTE) as part of the diagnostic work-up. We defined hypertensive sICH as typical localization of hemorrhage in patients with arterial hypertension and no other identified sICH etiology. We defined an increased end-diastolic interventricular septal wall thickness of ≥11 mm on TTE as a surrogate parameter for LVH. Results: Among 395 patients with sICH, 260 patients (65.8%) received TTE as part of their diagnostic work-up. The median age was 71 years (interquartile range (IQR) 17), 160 patients (61.5%) were male, the median baseline National Institute of Health Stroke Scale (NIHSS) score was 8 (IQR 13). Of these, 159 (61.2%) patients had a hypertensive sICH and 156 patients (60%) had LVH. In univariable (113/159 (71.1%) vs. 43/101 (42.6%); odds ratio (OR) 3.31; 95% confidence interval (CI95%) 1.97–5.62); and multivariable (adjusted OR 2.95; CI95% 1.29–6.74) analysis, hypertensive sICH was associated with LVH. Conclusions: In patients with sICH, LVH is associated with hypertensive bleeding etiology. Performing TTE is meaningful for diagnosis of comorbidities and clarification of bleeding etiology in these patients. Future studies should include long-term outcome parameters and assess left ventricular mass as main indicator for LVH.</jats:p>

Improving detection of cerebral small vessel disease aetiology in patients with isolated lobar intracerebral haemorrhage

“…Although some studies have reported increased frequency of hypertension in patients with HTN-cSVD compared with those with CAA,2 several other studies have demonstrated similar burdens of vascular risk factors between these two cSVD groups 8 28 29. Our study also did not show any differences between the frequency of vascular risk factors between the four cSVD groups among patients with isolated-LICH.…”

“…A single lobar ICH probably represents a relatively early phase of cerebral injury even among HTN-cSVD and this might explain the lack of significant differences in risk factor load. As reported in other studies, the admission blood pressure was not significantly different between patients with HTN-cSVD pattern and CAA pattern suggesting that the binary variable of hypertension (ie, the presence or absence) is a relatively non-specific risk factor that is unreliable at predicting underlying cSVD aetiology 8. To increase our ability to discriminate cSVD aetiologies, we employed LVH as sensitive non-invasive cardiac biomarker that has been associated with the presence of HTN-cSVD 8 28 30.…”

“…The presence of LVH (an imaging marker for hypertensive end-organ damage11 and hence HTN-cSVD2 8 12 13) was determined by screening transthoracic echocardiography reports within 1 year of the event. LVH was defined according to the American Society of Echocardiography guidelines using left ventricular mass indexed to body surface area (with a left ventricular mass index cut-off of >95 g/m 2 for women and >115 g/m 2 for men) 14.…”

“…Herein, we aimed to determine whether these NHIM can be used to improve the ability to differentiate cSVD subtypes in patients with isolated-LICH. Because there are no validated radiopathological criteria to diagnose HTN-cSVD, we used the presence of left ventricular hypertrophy (LVH), which has been demonstrated to be a surrogate marker for HTN-cSVD 8. We hypothesised that patients with isolated-LICH with the HTN-cSVD NHIM pattern have a higher frequency of LVH than patients with CAA pattern or patients with no NHIM.…”

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage

“…Lens contamination caused by the active bleeding can cause the doctor’s vision to be blurred. Hemostasis is relatively difficult, suggesting that preoperative evaluation should be done, and craniotomy planning should be performed, if necessary[ 15 ].…”