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)