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Hemodynamic and Functional Correlates of Concentric vs. Eccentric LVH in a Community-Based Sample With Prevalent

Hamza Bello1, Gavin R Norton1, Vernice R Peterson1

  • 1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

American Journal of Hypertension
|August 11, 2021
PubMed

Insights

Concentric left ventricular remodeling in hypertension is linked to increased blood flow and pressure, not just heart muscle growth. This remodeling, unlike eccentric hypertrophy, is associated with reduced systolic function.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Echocardiography

Background:

  • The relationship between concentric left ventricular (LV) remodeling and pressure vs. volume overload in primary hypertension remains unclear.
  • Understanding the factors contributing to LV remodeling is crucial for managing hypertensive heart disease.

Purpose of the Study:

  • To investigate the determinants of concentric left ventricular hypertrophy (LVH) and remodeling in a cohort with volume-dependent primary hypertension.
  • To differentiate the roles of pressure and volume overload in LV structural changes.

Main Methods:

  • Utilized central arterial pressure, echocardiography (aortic velocity and diameter), and LV mass index (LVMI) and relative wall thickness (RWT) measurements.
  • Analyzed associations between hemodynamic factors (e.g., systemic vascular resistance, arterial compliance) and LV remodeling parameters.
  • Included 709 participants of African ancestry with prevalent volume-dependent primary hypertension.

Main Results:

  • Both LVMI and RWT were positively associated with increased end-diastolic volume (EDV), stroke volume (SV), and peak aortic flow (Q).
  • Neither LVMI nor RWT showed significant associations with systemic vascular resistance (SVR), aortic characteristic impedance (Zc), or total arterial compliance (TAC).
  • Concentric and eccentric LVH were linked to elevated blood pressure (BP) and flow, but not altered vascular resistance or compliance. LV RWT, but not LVMI, was inversely associated with myocardial systolic function, with decreases noted in concentric LVH.

Conclusions:

  • In volume-dependent hypertension, concentric LVH is driven by increased systemic flow and blood pressure, similar to eccentric LVH.
  • Concentric remodeling, beyond hypertrophy, is associated with impaired systolic function.
Abstract

Keywords:
blood pressurehypertensionleft ventricular hypertrophyleft ventricular remodelingstroke volumesystolic function

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