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Relation of left ventricular geometry and function to systemic hemodynamics in hypertension: the LIFE Study. Losartan
J N Bella1, K Wachtell, V Palmieri
1Cornell Medical Center, New York, USA.
Insights
Systemic hemodynamics, including stroke volume (SV) and arterial stiffness, are linked to left ventricular (LV) geometry in hypertension. These hemodynamic factors may influence the development of different LV geometric patterns in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiovascular Physiology
Background:
- Left ventricular (LV) geometry is a known risk stratifier in hypertension.
- The precise relationship between LV geometry and systemic hemodynamic patterns in moderate hypertension remains incompletely understood.
Purpose of the Study:
- To investigate the association between systemic hemodynamic parameters and left ventricular (LV) geometric patterns in patients with moderate hypertension and target organ damage.
- To elucidate how hemodynamic factors may influence the development of different LV geometric phenotypes.
Main Methods:
- A cross-sectional case-control study utilizing echocardiographic data from the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE) and a normotensive reference group.
- Hypertensive patients (n=964) with LV hypertrophy and normal adults (n=366) were assessed using two-dimensional and Doppler echocardiography.
- Measurements included stroke volume (SV), cardiac output, peripheral resistance, and pulse pressure/SV (arterial stiffness), with analyses adjusted for covariates.
Main Results:
- Patients with eccentric LV hypertrophy exhibited higher mean stroke volume (SV) compared to normal adults, while those with concentric remodeling had lower SV.
- Pulse pressure/SV, an indicator of arterial stiffness, was significantly elevated in concentric remodeling and least elevated in eccentric hypertrophy.
- Multivariate analysis revealed independent relationships between LV mass and factors like systolic pressure, age, SV, gender, and BMI; relative wall thickness was associated with age, systolic pressure, lower SV, and BMI.
Conclusions:
- In hypertensive patients with electrocardiographic LV hypertrophy, stroke volume (SV) and pulse pressure/SV are associated with distinct left ventricular (LV) geometric phenotypes.
- These hemodynamic factors may play a role in stimulating the development of different LV geometric patterns in moderate hypertension.
Objectives:
To clarify the relations of systemic hemodynamics to left ventricular (LV) geometric patterns in patients with moderate hypertension and target organ damage.
Background:
LV geometry stratifies risk in hypertension, but relations of LV geometry to systemic hemodynamic patterns in moderately severe hypertension have not been fully elucidated.
Design:
Cross-sectional case-control study.
Setting:
Baseline findings in the echocardiographic substudy of the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE) and in a normotensive reference group.
Patients/Participants:
Nine hundred and sixty-four patients with Stage I-II hypertension and LV hypertrophy by Cornell voltage duration criteria ((SV3 + RaVL [+ 6 mm in women]) x QRS > 2440 mm x ms) or modified Sokolow- Lyon voltage criteria (SV1 + RV5/RV6 > 38 mm), and 366 apparently normal adults.
Interventions:
None.
Methods:
Two-dimensional and Doppler echocardiograms were used to classify hypertensive patients into groups with normal geometry, concentric remodelling and concentric and eccentric hypertrophy, and to measure stroke volume (SV), cardiac output, peripheral resistance and pulse pressure/SV as a measure of arterial stiffness. Comparisons were adjusted for covariates by general linear model with the Sidak post-hoc test
Results:
Mean SV was higher in patients with eccentric hypertrophy (83 ml/beat) and lower with concentric remodeling (68 ml/beat) than in normal adults (73 ml/ beat). Cardiac output was highest in patients with eccentric LV hypertrophy and lower with concentric remodeling than eccentric hypertrophy; mean pressure and peripheral resistance were equally high in all hypertensive subgroups, whereas pulse pressure/SV was most elevated (by a mean of 47% versus reference subjects) with concentric remodeling and least so (mean + 15%) with eccentric hypertrophy. In multivariate analysis (Multiple R + 0.68), LV mass was independently related to higher systolic pressure, older age, SV, male gender and body mass index (all P< 0.001). Relative wall thickness was independently related (Multiple R + 0.50) to older age, higher systolic pressure, lower SV (all P< 0.001) and higher body mass index (P + 0.007). SV and cardiac output were lower in patients with low stress-corrected midwall shortening.
Conclusion:
In patients with moderate hypertension and ECG LV hypertrophy, the levels of SV and pulse pressure/ SV, are associated with, and may be stimuli to different LV geometric phenotypes.
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