Tissue Characterization to Differentiate Pathological From Physiological Hypertrophy in Patients With Hypertension and Athletes

Abstract

Background: Although indicators of surgical and medical treatment have been applied to patients with typical dissection (AD) of the descending thoracic aorta, the natural history of descending aortic intramural hematoma (AIH) is not yet clearly known.Objective: The goal of this study was to test the hypothesis that the absence of flow communication through the intimal tear in AIH involving the descending aorta has a different clinical course compared with AD.Methods: We prospectively evaluated clinical and echocardiographic data between AD (76 patients) and AIH (27 patients) of the descending thoracic aorta.Results: Patients had no differences In age, gender, or clinical presentation. The development of pleural effussion or periaortic hematoma was more frequent in patients with AIH than it was in patients with AD. AIH and AD had same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Although medical treatment was selected in the same proportion between groups, surgical treatment was more frequently selected in AD (39% vs. 22%, p < 0.01). AD patients who received surgical treatment had higher mortality than those with AIH (36% vs. 17%, p < 0.01). There was no difference in mortality between patients who received medical treatment (15% in AD vs 14% in AIH, p = 0.7). In follow-up imaging studies of 23 patients with AIH,6 patients (25%) showed complete resolution and 6 patients (25%) increased the descending aortic diameter. Typical AD developed in 3 patients (13%). A three-year survival rate did not show significant difference (82 ± 6% in AIH vs 75 ± 7% in AD, p = 0.37).Conclusion: AIH of the descending thoracic aorta have relatively frequent complications at follow-up including dissection and aneurysm formation. Medical treatment with very close imaging follow-up and timed elective surgery in cases with complications allow better management for patients with AIH of the descending thoracic aorta.

Assessment of the Left Ventricular Chamber Stiffness in Athletes

“…Different types of cardiac remodeling affect differently chamber stiffness. Pathological conditions are usually associated with production of interstitial collagen 6 . Consequently, fibrosis of the myocardium increases stiffness and interferes with the heart filling 1 .…”

“…Pathological conditions are usually associated with production of interstitial collagen. 6 Consequently, fibrosis of the myocardium increases stiffness and interferes with the heart filling. 1 In physiologic left ventricular (LV) hypertrophy the increase in ventricular mass is characterized by a normal organization of cardiac structure and no collagen increase.…”

Clinical Value of the Tissue Doppler S Wave to Characterize Left Ventricular Hypertrophy as Defined by Echocardiography

“…Many studies have described the use of DTI in the assessment of the cardiomyopathies, coronary artery disease, valvular disease, and other conditions 6–8 . In our laboratory, we use color DTI in addition to tissue characterization as part of the evaluation of patients with increased LV mass 9,10 …”

“…[6][7][8] In our laboratory, we use color DTI in addition to tissue characterization as part of the evaluation of patients with increased LV mass. 9,10 This study was designed to test the hypothesis that color DTI measurements of the s wave and two related indices-IC/s ratio and the velocity difference between two points at the basal and mid septum (BMDV)-could further our understanding of ventricular hypertrophy and refine its characterization.…”