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Relation of left ventricular hypertrophy and geometry to asymptomatic cerebrovascular damage in essential
1Department of Geriatric Medicine, Ehime University School of Medicine, Japan. koharak@m.ehime-u.ac.jp
Insights
Left ventricular hypertrophy, a marker of heart enlargement, is linked to silent brain damage in essential hypertension patients. This finding highlights the prognostic value of cardiac geometry in predicting cerebrovascular issues.
Area of Science:
- Cardiology
- Neurology
- Hypertension Research
Background:
- Increased left ventricular (LV) mass and abnormal geometry are known prognostic indicators for cardiovascular events.
- Preclinical brain damage in essential hypertensive patients has not been extensively studied in relation to LV hypertrophy.
Purpose of the Study:
- To investigate the association between left ventricular (LV) hypertrophy and asymptomatic cerebrovascular damage in essential hypertensive patients.
- To emphasize the role of LV geometry in this relationship.
Main Methods:
- 150 essential hypertensive patients were categorized into four groups based on LV mass index and relative wall thickness: normal, concentric remodeling, eccentric hypertrophy, and concentric LV hypertrophy.
- Magnetic resonance imaging (MRI) was used to evaluate lacunar lesions and leukoaraiosis.
- Statistical analyses, including chi-square, ANOVA, and stepwise regression, were employed.
Main Results:
- The prevalence and number of lacunar lesions were significantly higher in patients with LV remodeling and hypertrophy compared to those with normal LV.
- Leukoaraiosis severity was significantly greater in patients with LV hypertrophy versus those with a normal left ventricle.
- LV mass index and relative wall thickness were independent predictors of asymptomatic cerebrovascular damage, alongside age and systolic blood pressure.
Conclusions:
- LV hypertrophy, particularly concentric LV hypertrophy, provides significant prognostic information regarding pre-clinical brain damage in hypertensive individuals.
- Cardiac geometry assessment is crucial for identifying hypertensive patients at risk for cerebrovascular complications.
Abstract:
Increased left ventricular (LV) mass and abnormal geometry have a powerful prognostic value for cardiovascular morbidity and mortality including stroke. However, there have been no studies on the association between LV hypertrophy and preclinical brain damage in essential hypertensive patients. In the present study, we investigated the relation between LV hypertrophy and asymptomatic cerebrovascular damage identified by magnetic resonance imaging in 150 essential hypertensive patients, with an emphasis on LV geometry. Patients were divided into the following 4 groups according to their LV mass index and relative wall thickness; normal ventricular geometry (n = 50), concentric remodeling (n = 22), eccentric hypertrophy (n = 44), and concentric LV hypertrophy (n = 34). Lacunar lesions and leukoaraiosis were evaluated. The prevalence of lacunae was significantly higher in patients with LV remodeling than in patients with normal LV (chi-square 19.6, p = 0.0002). The number of lacunae was significantly higher in patients with LV hypertrophy than in patients with normal LV or concentric remodeling (F [3,146] = 8.03, p<0.0001). The severity of leukoaraiosis was also significantly greater in patients with LV hypertrophy than in patients with a normal left ventricle (chi-square 14.5, p = 0.02). Stepwise regression analysis confirmed that LV mass index and relative wall thickness, in addition to age and systolic blood pressure, were independent predictors for asymptomatic cerebrovascular damage, even in the absence of neurologic abnormalities. In hypertensive patients, LV hypertrophy, and especially concentric LV hypertrophy, provides important prognostic information on the presence of pre-clinical brain damage.