ABC | Volume 113, Nº1, July 2019

Statement Position Statement on Indications of Echocardiography in Adults – 2019 Arq Bras Cardiol. 2019; 113(1):135-181 Table 5 – Recommendations of echocardiography in non-compaction cardiomyopathy Recommendation Class of recommendation Level of evidence NCC clinical suspicion I C Reassessment of patients with known NCC when there is change of symptoms or new cardiovascular event I C Screening in first-degree relatives of NCC patients I C Carriers of muscular diseases and/or other clinical syndromes that may be related I C Use of new techniques such as strain, 3D echocardiography and echocardiographic contrast for complementary evaluation and aid in differential diagnosis IIa B Routine reassessment of clinically stable patients with no change in therapy III C NCC: non-compaction cardiomyopathy. Table 6 – Degree of abnormalities of left ventricular mass 95,99 Linear method Female Male Normal Slight increase Moderate increase Severe increase Normal Mild increase Moderate increase Severe increase LV mass, g 67 to 162 163 to 186 187 to 210 ≥ 211 88 to 224 225 to 258 259 to 292 ≥ 293 Mass/BS, g/m² 43 to 95 96 to 108 109 to 121 ≥ 122 49 to 115 116 to 131 132 to 148 ≥ 149 Mass/height, g/m 41 to 99 100 to 115 116 to 128 ≥ 129 52 to 126 127 to 144 145 to 162 ≥ 163 Mass/height 2,7 , g/m 2,7 18 to 44 45 to 51 52 to 58 ≥ 59 20 to 48 49 to 55 56 to 63 ≥ 64 RWT (2 x LVPW/LVDD) 0.22 to 0.42 0.43 to 0.47 0.48 to 0.52 ≥ 0.53 0.24 to 0.42 0.43 to 0.46 0.47 to 0.51 ≥ 0.52 Septum thickness, cm 0.6 to 0.9 1.0 to 1.2 1.3 to 1.5 ≥ 1.6 0.6 to 1.0 1.1 to 1.3 1.4 to 1.6 ≥ 1.7 LVPW thickness, cm 0.6 to 0.9 1.0 to 1.2 1.3 to 1.5 ≥ 1.6 0.6 to 1.0 1.1 to 1.3 1.4 to 1.6 ≥ 1.7 2D Method LV mass, g 66 to 150 151 to 171 172 to 182 ≥ 193 96 to 200 201 to 227 228 to 254 ≥ 255 Mass/BS, g/m² 44 to 88 89 to 100 101 to 112 ≥ 113 50 to 102 103 to 116 117 to 130 ≥ 131 LV: left ventricle; BS: body surface; RWT: relative wall thickness; LVPW: left ventricle posterior wall; LVDD: left ventricle diastolic diameter; 2D: two-dimensional. perception of the need to actively investigate first-degree relatives affected by the disease (described in 13 to 50% of this specific group). 93 On the other hand, increasingly frequent “exam findings” (physiological versus pathological variants) have been reported in clinical practice, leading to the worrisome excess of diagnoses. 7 Therefore, it is recommended to carry out a comprehensive evaluation, including clinical, electrocardiographic data and careful analysis of the findings in complementary imaging studies. 94 The recommendations for performing the echocardiography in NCC are set out in table 5. 2.4. Arterial Hypertension and Myocardial Hypertrophy The elevation of systolic stress in the LV wall, secondary to systemic arterial hypertension (SAH), can produce myocardial hypertrophy by increasing ventricular mass. 95 Unlike physiological hypertrophy (growth, pregnancy and physical activity), characterized by preserved cardiac structure and function, left ventricular hypertrophy (LVH), secondary to SAH, is commonly associated with fibrosis, myocardial dysfunction and increased mortality. 96 The echocardiography is the clinical choice exam to detect LVH, due to its being more accurate than the electrocardiogram 97,98 and allowing estimation of LV mass (LVM). The methodology to measure LVM and to define its cut-off points and index form (body surface, height, weight) varies between studies. Most echocardiography authors and laboratories follow the recommendations published by ASE and EACVI. 95,99 LVM indexing to the body surface area in g/m² is the most used one, 100 and normality values are different for men and women (Table 6). 95,99 Cumulative exposure to elevated blood pressure levels among young adults is associated with LV systolic dysfunction in mid-life. 101 The presence of LVH is considered as evidence of target organ damage in hypertensive patients, and its association with cardiovascular diseases and mortality is well documented. 102-104 Such an increase in cardiovascular risk in hypertensive patients is directly related to LVM, regardless of blood pressure values. 103 In addition to LVM, the geometric pattern of LVH is also seen as an important variable related 148