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[Prognostic implications of left ventricular hypertrophy in arterial hypertension]
1Département de recherche clinique de l'Evans Memorial, Boston.
Insights
Left ventricular hypertrophy (LVH) significantly increases cardiovascular disease risk, independent of hypertension. Key risk factors include age, blood pressure, and obesity, highlighting the need for targeted interventions.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Research
Context:
- The Framingham study investigated left ventricular hypertrophy (LVH) over 34 years.
- LVH is a known precursor to various cardiovascular diseases.
Purpose:
- To analyze the long-term impact and risk factors associated with left ventricular hypertrophy (LVH).
- To compare the prognostic significance of different LVH detection methods.
Summary:
- LVH, detected via electrocardiogram, chest X-ray, or echocardiography, elevates risks for coronary artery disease, heart failure, stroke, and peripheral arterial disease.
- Hypertension is the primary cause of LVH, but age and obesity also independently contribute to electrocardiographic LVH (ECG-LVH).
- ECG-LVH, especially with St-T wave changes, indicates a poor prognosis, similar to silent myocardial infarction, and worsens outcomes in patients with existing coronary artery disease.
Impact:
- LVH's contribution to cardiovascular risk is threefold that of hypertension.
- Electrocardiographic LVH carries a worse prognosis than radiographic LVH, suggesting distinct pathophysiological mechanisms.
- Understanding LVH's independent risk factors and prognostic implications is crucial for cardiovascular disease prevention and management.
Abstract:
Left ventricular hypertrophy (LVH) has been studied as a condition predisposing to cardiovascular disease over a 34 year period in the Framingham study. Whether present on the electrocardiogramme, chest X-ray or echocardiography, LVH is a harbinger of cardiovascular disease. It increases the risks of coronary artery disease, cardiac failure, cerebral haemorrhage and peripheral arterial disease. Its contribution to global cardiovascular risk is three times greater than that of hypertension which is the principal cause of LVH. Age, blood pressure and obesity are the three essential factors predisposing to LVH. Each contributes independently to the development of electrocardiographic hypertrophy (ECG-LVH). Increased left ventricular mass detected by echocardiography is commoner with age but apparently as the consequence of an increased prevalence of hypertension, obesity, coronary artery and valvular heart disease with age. The increase of left ventricular mass with age seems largely to be due to fatty hypertrophy and to hypertension. The risk associated with ECG-LVH is particularly important when St-T wave changes are associated with increased voltage. The outcome and prognosis of ECG-LVH and of silent myocardial infarction are similar. When overt coronary artery disease is present, ECG-LVH further increases the risk of cardiovascular events. Electrocardiographic LVH carries a worse prognosis than radiographic LVH which corresponds to anatomic hypertrophy. As the two forms of LVH contribute independantly to the cardiovascular risk, it is probable that they result from different physiopathological mechanisms.