[Diagnostic methods and the prognosis of the heart-hypertension interaction: cardiac echo-Doppler].

Among all the cardiovascular risk factors, Left Ventricular Hypertrophy (LVH) is the most important and its diagnosis by echocardiography is essential in routine evaluation of Arterial Hypertension (AHT). Calculation of the cardiac mass and of the relative thickness of the left ventricular wall are necessary steps in morphological classification of the heart of AHT into four subtypes: normal, concentric remodeling, concentric and eccentric hypertrophy. Study with M and 2D echo can be complemented by the analysis of systolic function and ventricular afterload. Alteration of the diastolic function by pulsed Doppler is sometimes the first sign of cardiac dysfunction in AHT. The three classic patterns of mitral filling, prolonged relaxation, restrictive and pseudonormal, often give only a rough analysis. The diversity of the factors involved in diastolic dysfunction opens the door to new indicators derived from analysis of flow in the pulmonary veins, especially the relative amplitude of the inverted "a" (ar) and "decalage" between this and the A of the anterograde mitral flow. The "decalage" between the inverted A (Ar) of the left ventricular outflow in relation to the mitral A is the latest approximation in the study of ventricular compliance. The poor overall prognosis which is implied by an increase in cardiac mass is modified by the geometric subtypes, the high morbidity and mortality of concentric hypertrophy being apparently noteworthy. The true prognostic significance of the regression of LVH and the accompanying diastolic dysfunction are still subject to debate.