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Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension
A Ganau1, R B Devereux, M J Roman
1Institute of Clinical Medicine, University of Sassari, Italy.
Insights
Hypertension causes diverse left ventricular changes. Concentric remodeling and eccentric hypertrophy are more common than typical concentric hypertrophy in untreated patients, influencing systemic hemodynamics.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Arterial hypertension is a major risk factor for cardiovascular disease.
- Left ventricular (LV) geometric adaptation to hypertension is complex and not fully understood.
- Previous studies often focused on typical concentric hypertrophy, potentially overlooking other adaptations.
Purpose of the Study:
- To investigate the spectrum of left ventricular geometric patterns in untreated essential hypertension.
- To correlate these geometric patterns with systemic hemodynamics.
- To understand the underlying load conditions associated with different LV adaptations.
Main Methods:
- Two-dimensional and M-mode echocardiography were used.
- 165 patients with untreated essential hypertension were studied.
- 125 age- and gender-matched healthy adults served as controls.
Main Results:
- 52% of hypertensive patients had normal LV mass and relative wall thickness.
- 13% showed concentric remodeling (increased relative wall thickness, normal mass).
- 27% had eccentric hypertrophy (increased mass, normal relative wall thickness).
- 8% exhibited typical concentric hypertrophy (increased mass and relative wall thickness).
- Systemic hemodynamics varied, with higher peripheral resistance in remodeling/hypertrophy groups and super-normal cardiac index in eccentric hypertrophy.
- LV cavity shape correlated with stroke volume, being more elliptic in concentric remodeling and spherical in eccentric hypertrophy.
Conclusions:
- Untreated essential hypertension presents a spectrum of LV geometric adaptations beyond typical concentric hypertrophy.
- Concentric remodeling and eccentric hypertrophy are more prevalent than concentric hypertrophy.
- These adaptations are closely matched to systemic hemodynamics and the nature of the ventricular load (pressure vs. pressure and volume overload).
Abstract:
The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass ("concentric remodeling"), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had "typical" hypertensive concentric hypertrophy (increase in both variables). Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was super-normal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular short-axis/long-axis ratio was positively related to stroke volume (r = 0.45, p less than 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume "underload" of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload. Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.