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[Morphological and functional characteristics of the heart in untreated hypertension]
P Gosse1, R Roudaut, P Durandet
1Hôpital cardiologique, centre hospitalier et universitaire de Bordeaux, Pessac.
Insights
Hypertensive heart disease presents in varied forms. Eccentric left ventricular hypertrophy (LVH) can occur in younger patients with normal function despite high stress, while asymmetric LVH is more common in older individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Hypertensive heart disease (HHD) encompasses various cardiac manifestations of hypertension.
- Understanding the specific forms of HHD is crucial for accurate diagnosis and management.
- Left ventricular hypertrophy (LVH) is a key indicator of cardiac adaptation to chronic hypertension.
Purpose of the Study:
- To delineate the distinct echocardiographic patterns of left ventricular hypertrophy (LVH) in untreated hypertensive patients.
- To investigate the relationship between LVH morphology, patient demographics, and hemodynamic parameters.
- To assess the impact of different LVH types on left ventricular (LV) filling and systolic function.
Main Methods:
- Echocardiography (2D guided M-mode and Doppler) was used to assess LV structure and filling in 118 newly diagnosed, untreated hypertensive patients.
- 24-hour ambulatory blood pressure (BP) monitoring was performed in 86 patients.
- Recordings were analyzed blindly, and LVH was classified using Devereux's criteria.
Main Results:
- Two main patterns of LVH were observed: eccentric and asymmetric.
- Eccentric LVH was associated with younger age, normal systolic function, and preserved LV filling despite elevated parietal stress.
- Asymmetric LVH was more prevalent in older patients, characterized by septal thickening and independent of BP, with no significant impact on LV function.
Conclusions:
- Eccentric LVH can manifest in young hypertensive individuals with preserved cardiac function.
- Asymmetric LVH is a common finding in older hypertensive patients, primarily involving septal thickening.
- These distinct patterns of LVH in hypertensive heart disease highlight the heterogeneity of cardiac remodeling in response to elevated blood pressure.
Unlabelled:
To better define the different forms of hypertensive heart disease, we performed 2D guided M mode echo recording of the left ventricle (LV) and Doppler assessment of LV filling in 118 newly recognised (less than 1 year) and untreated hypertensive patients (mean age +/- SD: 49 +/- 10 years, 80 males, 38 females). All recordings were read "blindly". 86 patients underwent also 24 hours BP monitoring during daily routine.
Main Results:
1) The relative wall thickness (h/r) shows a normal distribution: mean = 0.39; SD = 0.08; 1st quartile = 0.33; 3rd = 0.43; 2) The septal/posterior wall ratio (ST/PWT) shows also a normal distribution: mean = 1.14; SD = 0.24; 1st quartile = 1; 3rd = 1.3; 3) Among patients with LVH (Devereux's criteria, n = 65) the 6 patients with h/r less than or equal to 0.33 are significantly different from the 18 patients with h/r greater than or equal to 0.43 for age (44 +/- 8 vs 51 +/- 10; p less than 0.03), casual (146 +/- 7 vs 166 +/- 13 mmHg; p less than 0.05) and ambulatory SBP (135 +/- 19 vs 146 +/- 16 mmHg; p less than 0.05), peak systolic stress (280 +/- 15 vs 187 +/- 31 Dynes/cm2; p less than 0.001) and E/A ratio (1.17 +/- 0.01 vs 0.94 +/- 0.27; p less than 0.05) but not for ponderal excess. 4) Patients with asymmetric LVH(ST/PWT greater than 1.3 in 22; greater than 1.5 in 10) are significantly different from patients with symmetric LVH for age (54 +/- 10 vs 47 +/- 10; p less than 0.03), diastolic diameter (51 +/- 5 vs 53 +/- 5 mm; p less than 0.02), ST (13.2 +/- 2.9 vs 10 +/- 1.9 mm; p less than 0.001) and PWT (8.9 +/- 1.5 vs 9.7 +/- 1.5 mm; p less than 0.02) but not for BP fractional shortening and LV filling.
Conclusion:
eccentric LVH may be found in young hypertensive patients with normal systolic function and LV filling despite high parietal stress; asymmetric LVH is more frequent in older patients in which LVH seems to develop rather on the septum than on free wall, independently of BP and without consequences on LV function.