Echocardiographic patterns of myocardial fibrosis in hypertensive patients

Endomyocardial biopsy versus ultrasonic tissue characterization

M. Ciulla, R. Paliotti, D. B. Hess, E. Tjahja, S. E. Campbell, F. Magrini, Karl Weber

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Echocardiographic image texture has been demonstrated to reflect the physical properties of the tissue under examination. To evaluate the role of collagen in determining the echo pattern of the left ventricular wall, we studied nine hypertensive patients with left ventricular hypertrophy (left ventricular mass index > 125 gm/m2) and biopsy-proven different degrees of myocardial fibrosis by analyzing the echocardiographic examinations performed before the biopsy. Myocardial tissue was sampled under fluoroscopy and two-dimensional echo guidance in the interventricular septum. Collagen volume fraction (CVF; normal range up to 2%) was taken as an index of fibrosis. The echo patterns were assessed by analyzing standard two-dimensional parasternal long-axis echocardiograms recorded on videotape. Images were color-coded at 256 levels (0 = yellow, 256 = black) and digitized off-line onto a personal computer. The region of analysis was set using a selection tool (20 × 10 mm) in the general area of septum where the specimen was taken. For each selection a color-level histogram, representing the frequency distribution, was derived with estimates of the average pixel intensity (mCS), skewness (SK), kurtosis (K), and the broad band (Bb) of the echoes about the distribution. Echo-derived parameters in each patient were compared with corresponding CVF values. CVF was out of range in all patients, ranging from 2.6% to 7.6% (mean 4.3% ± 1.6%). No correlation was found between CVF and mCS, whereas a significant correlation was found at end diastole between CVF and the parameters describing histogram morphology, respectively, SK (r = 0.73), K (r = 0.69), Bb (r = 0.72). These findings for the first time demonstrate in vivo in hypertensive patients with left ventricular hypertrophy an agreement between echo amplitude and histologically assessed collagen volume. Thus in our studied patients collagen content appears to be the major determinant of regional echo intensity, its increase resulting in a significant and progressive wider asymmetrical left shift (yellow) of the color histogram.

Original languageEnglish (US)
Pages (from-to)657-664
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume10
Issue number6
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

Fingerprint

Ultrasonics
Fibrosis
Biopsy
Collagen
Color
Left Ventricular Hypertrophy
Videotape Recording
Diastole
Fluoroscopy
Microcomputers
Reference Values

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Echocardiographic patterns of myocardial fibrosis in hypertensive patients : Endomyocardial biopsy versus ultrasonic tissue characterization. / Ciulla, M.; Paliotti, R.; Hess, D. B.; Tjahja, E.; Campbell, S. E.; Magrini, F.; Weber, Karl.

In: Journal of the American Society of Echocardiography, Vol. 10, No. 6, 01.01.1997, p. 657-664.

Research output: Contribution to journalArticle

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