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Left ventricular hypertrophy in hypertension as a predictor of coronary events: relation to geometry
Giovanni de Simone1, Vittorio Palmieri
1Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy. simogi@unina.it
Insights
Left ventricular hypertrophy (LVH) strongly predicts coronary heart disease (CHD). LVH directly worsens CHD through mechanisms like increased oxygen demand and impaired coronary flow, even before other symptoms appear.
Area of Science:
- Cardiology
- Pathophysiology
- Epidemiology
Background:
- Left ventricular hypertrophy (LVH) is a significant clinical finding.
- LVH is associated with increased risk factors for atherosclerosis and acute cardiac events.
Purpose of the Study:
- To review epidemiological evidence linking LVH to coronary heart disease (CHD).
- To explore pathophysiological mechanisms connecting LVH and coronary events.
Main Methods:
- Review of epidemiological studies on LVH and CHD.
- Analysis of biological mechanisms linking LVH to coronary events.
Main Results:
- LVH is a powerful predictor of CHD, especially with concentric geometry.
- LVH directly contributes to CHD development and severity via increased myocardial oxygen demand, coronary hypertension, endothelial dysfunction, reduced coronary reserve, diastolic dysfunction, and cardiac remodeling.
- Impaired coronary reserve in LVH can precede other signs of heart disease.
Conclusions:
- LVH is a critical independent risk factor for CHD.
- Understanding the mechanisms linking LVH to CHD is crucial for early diagnosis and intervention.
- Abnormal coronary hemodynamics in LVH may represent an early stage of the disease process.
Abstract:
The present review examines epidemiological evidence for a relation of left ventricular hypertrophy with coronary heart disease, and mechanisms that may represent pathophysiological links between left ventricular hypertrophy and coronary events. Left ventricular hypertrophy has been demonstrated to be a powerful predictor of coronary heart disease, and when geometry is concentric the relation is even stronger. In addition to its association with risk factors for atherosclerosis and mechanisms that precipitate acute heart attacks, left ventricular hypertrophy also directly predisposes to and aggravates clinical presentation of coronary heart disease through a number of biological mechanisms. These include the following: increase in oxygen requirement related to left ventricular geometry; coronary hypertension, with endothelial dysfunction and reduced coronary reserve; diastolic dysfunction; and structural remodelling of myocardium and vascular bed. Some of these alterations are also worsened by underlying coronary heart disease, and can potentially be maintained by loop mechanisms. A recognizable stage of abnormal coronary haemodynamics in the context of left ventricular hypertrophy is probably that at which coronary reserve is impaired in the absence of any other sign of heart disease; in many circumstances, this may occur early in the disease process.