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Diversity of patterns of hypertrophy in patients with systemic hypertension and marked left ventricular wall
1Department of Medicine, Howard University College of Medicine, Washington, DC.
Insights
Asymmetric left ventricular (LV) hypertrophy, often seen in hypertrophic cardiomyopathy, can also occur in severe hypertensive heart disease. This study found that 34% of hypertensive patients exhibited asymmetric LV hypertrophy patterns.
Area of Science:
- Cardiology
- Cardiovascular Imaging
Background:
- Differentiating left ventricular (LV) hypertrophy due to systemic hypertension from hypertrophic cardiomyopathy is clinically challenging.
- Understanding the patterns of LV hypertrophy in hypertension is crucial for accurate diagnosis and management.
Purpose of the Study:
- To characterize the patterns of LV hypertrophy in patients with sustained systemic hypertension and significant wall thickening.
- To determine the prevalence of asymmetric LV hypertrophy in this patient cohort.
Main Methods:
- Two-dimensional echocardiography was utilized to assess LV hypertrophy patterns.
- 102 patients with systemic hypertension and marked LV wall thickening (>15 mm) were included.
- Hypertrophy distribution was classified as symmetric (concentric) or asymmetric.
Main Results:
- Most patients (66%) showed symmetric (concentric) LV hypertrophy.
- A significant proportion (34%) exhibited asymmetric LV hypertrophy patterns.
- Asymmetric patterns resembled those seen in hypertrophic cardiomyopathy, involving septum and/or free wall segments.
Conclusions:
- Asymmetric LV hypertrophy is an important feature within the spectrum of severe hypertensive heart disease.
- Echocardiographic assessment can identify these distinct patterns in hypertensive patients.
- This finding aids in distinguishing hypertensive heart disease from primary cardiomyopathies.
Abstract:
In selected patients with systemic hypertension it may be difficult to ascertain whether left ventricular (LV) hypertrophy is a secondary end-organ consequence of long-term elevations in blood pressure or, alternatively, a manifestation of a coexistent primary hypertrophic cardiomyopathy. To address this issue and better characterize LV hypertrophy in systemic hypertension, 2-dimensional echocardiography was used to define the patterns of LV hypertrophy in 102 patients with sustained systemic hypertension and marked degrees of wall thickening. Patients ranged in age from 31 to 88 years (mean 61) and were predominantly female (58%); all were black. By selection, each patient had a maximal LV wall thickness of greater than 15 mm (range 16 to 29). Distribution of hypertrophy was judged to be symmetric (i.e., concentric) in most patients (67 of 102, 66%). However, a substantial proportion (35 patients, 34%) demonstrated nonuniform, asymmetric patterns of hypertrophy in which at least 1 segment of the LV wall was at least 1.5 times the thickness of any other. In these 35 patients, the distribution of hypertrophy was similar to that characteristic of the morphologic spectrum of hypertrophic cardiomyopathy, with thickening of portions of both the ventricular septum and free wall in 16 patients, anterior and posterior ventricular septum alone in 11 patients and segmental involvement of only the anterior ventricular septum in 8. Patients with asymmetric patterns of wall thickening did not differ from the patients with symmetric hypertrophy with regard to age, sex or clinical findings. Asymmetric LV hypertrophy appears to represent an important feature of the morphologic spectrum of severe hypertensive heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)