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Pierre-Yves Courand
Fédération de Cardiologie du Pr Pierre Lantelme, Hôpital de la Croix-Rousse / Hôpital Lyon Sud
CREATIS, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud
Hypertensive Cardiomyopathy:
New Insights
☑ Je déclare les liens d'intérêt potentiel suivants :
Bourses de Recherche : Fédération Française de Cardiologie
Honoraires : Amgen, CVRX, Janssen
Speaker's name : Pierre-Yves, Courand, Lyon
Disclosure Statement of Financial Interest
I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company
or I receive compensation or fees or research grants with a commercial company :
How Explore Hypertensive Cardiomyopathy ?
How explore hypertensive myocardiopathy ?
1. ECG: Old Tool and New Concepts
2. Cardiac Imaging: Routine and Future
3. Circulating Biomarkers: Another Point of View
1.ECG: Old Tool and New Concepts
Old Tool and New Concepts
Recommandations to detect electrical LVH
Williams B et al. J Hypertens 2018
R wave in aVL Lead: The simple, the better ?
Gosse P et al. J Hypertens 2012 Courand PY et al. J Hypertens 2014Courand PY et al. Am J Hypertens 2015
Diagnosis in comparison to Cardiac MRIOptimal Threshold 1,1 mV
Pronostic Value : CV Events and MortalityOptimal Threshold 0,6 mV
Electrical and Anatomic LVH
Chrispin J et al. JACC 2014Aro AL et al. Circ Arrhytm Electrophysiol 2015
2. Cardiac Imaging: Routine and Future
How to measure left ventricular mass ?
Lang RM et al. Eur Heart J Cardiovasc Imaging 2015;16:233-71
1) M-mode tracing 2) Bidimensionnal 3) 2D Based Formula 4) 3D
Indexation of LVM and different remodeling
Lang RM et al. Eur Heart J Cardiovasc Imaging 2015;16:233-71Chirinos JA, et al. Hypertension 2010;56:91-8Perrone-Filardi P et al. J Hypertens 2017;35:1727-41
1) Normal Values 2) Indexation 3) Different Remodeling
LVHMen : > 115 g/m² (M), >102 g/m² (2D)
Women : > 95 g/m² (M), > 88 g/m² (2D) RWT : (2 x PW) / LVID
• To Body surface area
• To Height particularly in Obese patientsMen >50 g/m2,7
Women> 47g/m2,7
GLS predicts CVE on top of Concentric Hypertrophy
Saito M et al. JACC Cardiovascular Imaging 2016
N = 388, Pas d’IC, Follow-up 4 ans, MACE N=72
Myocardial Assessment With Cardiac MRI
Kuruvilla S et al. JACC Cardiovascular Imaging 2015;8:172-80
3. Circulating Biomarkers: Another Point of View
3 Subgroups of Biomarkers
Wang TJ et al. Circulation 2011; Nilsson P et al. Hypertension 2009
Genetic: Birth but Persist
Cardiovascular
Events
Naissance 40 ans 80 ans
Imaging: Cumulative
LVH ECG, Echo
Circulating: Snapshot
NT-proBNP, sST-2SNP chromosome 9p21
Circulating Biomarkers Subtypes
Inflammation / Fibrosis:• Galectin 3
Neuro-Hormonal Activation:• MR-proADM
Nécrosis / Ischemia:• Troponine
Biomechanical Stress:• BNP/NT-proBNP• sST2• MR-proANP
Plasma NT-proBNP: Biomechanical Stress
Detection of LVH (MRI)
Courand PY et al. Hypertens Res 2014
Optimal Cut-off 200 pg/mL
Prognostic Value
Paget V et al. Hypertension 2011
N = 684, No HF, Follow-up 6 ans
Cox Multivarié : All-cause MortalityGroupe 2 vs. 1 : HR = 1,99Groupe 3 vs. 1 : HR = 3,30
sST2 and Galectin: Anatomic LVH
Farcas AB et al. Disease Markers 2017
AUC 0,771
Yao Y et al. J Clin Hypertens 2016;18:506-511
Galectin 3
Optimal Cut-off 11 ng/mLsST2
Optimal Cut-off 14 ng/mL
Mc Evoy JW et al. Circulation 2015;132:825-833
Hs Troponin: Necrosis Biomarker
ARIC Cohort: 5631 nomotensive patients with a median 6 years follow-up period1% developped electrical LVH
Tropo US (Roche diagnostic) : detection threshold 5 ng/L (reference group)
Electrical LVH according to Cornell Index
Take Home Message
• ECG:
• RaVL: 1,1 mV diagnostic value, 0,6 mV prognostic value
• Electrical and Anatomical LVH not strictly overlapping
• Transthoracic echocardiography
• LVM: M-mode, Bidimensionnal, 2D based formula, 3D• Thresholds: Men> 115 g/m² (M), >102 g/m² (2D); Women : > 95 g/m² (M), > 88 g/m² (2D)• Indexation to height2,7 : Men >50 g/m2,7, Women >47 g/m2,7
• LV Global Longitudinal Strain: cardiovascular events
• Circulating Biomarkers
• Pronostic Value: NT-proBNP > 133 pg/mL
• LVH: NT-proBNP (200 pg/mL), sST2 (14 ng/mL), Galectin 3 (11ng/mL)
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