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Normalization of cardiac structure and function after regression of cardiac hypertrophy
G B Habib1, D L Mann, W A Zoghbi
1Section of Cardiology, Veterans Affairs Medical Center, Methodist Hospital, Houston, TX 77030.
Insights
Antihypertensive treatment normalized left ventricular mass and improved systolic and diastolic function in hypertensive patients. This study confirms that reducing blood pressure effectively reverses cardiac changes, restoring normal heart function compared to healthy individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
- The impact of LVH regression on cardiac function remains debated.
- Previous studies lacked age-matched control groups for comparison.
Purpose of the Study:
- To assess the effect of antihypertensive treatment on left ventricular mass, systolic function, and diastolic function.
- To compare cardiac function in treated hypertensive patients with age-matched normotensive controls.
- To investigate the influence of LVH regression on cardiac performance.
Main Methods:
- Echocardiographic and Doppler studies were performed on 27 hypertensive patients before and up to 7 months after treatment.
- 27 age-matched normotensive subjects served as controls.
- Left ventricular mass, systolic function (shortening fraction vs. end-systolic wall stress), and diastolic filling dynamics were assessed.
Main Results:
- Antihypertensive treatment significantly reduced diastolic blood pressure and left ventricular mass index within 3 months.
- Left ventricular mass index normalized, becoming similar to control subjects.
- Systolic function remained unchanged overall but improved in patients with initially depressed function.
- Ventricular filling dynamics improved and normalized within 3 months, similar to controls.
Conclusions:
- Sustained hemodynamic unloading normalizes left ventricular mass in hypertensive patients.
- Antihypertensive therapy improves both systolic and diastolic ventricular function.
- Cardiac function in treated hypertensive patients becomes comparable to age-matched controls.
Abstract:
Previous studies have shown regression of left ventricular hypertrophy after pharmacologic treatment of hypertensive patients; however, the impact of regression of left ventricular hypertrophy on systolic function and on left and right ventricular diastolic function remains controversial and is difficult to assess because previous studies have not included concurrently studied age-matched control groups. Left ventricular mass, systolic function, and left and right ventricular diastolic function were assessed in 27 hypertensive patients, aged 43 +/- 6 years, by echocardiographic and Doppler studies before and 1, 3, 5, and 7 months after treatment. Left ventricular mass and ventricular function were concurrently evaluated in 27 age-matched normotensive subjects. Treatment with antihypertensive agents resulted in a significant (p < 0.001) reduction in diastolic blood pressure of 15 mmHg, measured at 1 month and sustained throughout the study. In response to hemodynamic unloading, left ventricular mass index decreased from 129 +/- 30 gm/m2 at baseline to 105 +/- 26 (p < 0.05) and 88 +/- 14 gm/m2 (p < 0.05) at 1 and 3 months of treatment, respectively, and remained unchanged over the subsequent 4 months. After 3 months of treatment, left ventricular mass index was similar in treated hypertensive and control subjects. Systolic function, assessed in terms of the relationship between shortening fraction and end-systolic wall stress, was unchanged throughout the treatment period and was no different from that in control subjects. However, patients with an initially depressed shortening fraction experienced a greater increase in shortening fraction during treatment compared to those with an initially normal shortening fraction (11% +/- 4% vs 5% +/- 5%, p < 0.01) and showed an improvement in the relationship between shortening fraction and end-systolic wall stress during treatment. Ventricular filling dynamics improved during the first 3 months of treatment, after which they were unchanged. Ventricular filling dynamics were similar in treated hypertensive patients and control subjects. In conclusion, sustained hemodynamic unloading of the left ventricle results in normalization of left ventricular mass, systolic function, and left and right ventricular diastolic filling dynamics, compared to those in age-matched control subjects.