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Asymmetric left ventricular remodeling due to isolated septal thickening in patients with systemic hypertension and
P Verdecchia1, C Porcellati, I Zampi
1Division of Medicine, General Hospital R. Silvestrini, Perugia, Italy.
Insights
Early identification of left ventricular (LV) remodeling in essential hypertension is crucial. Asymmetric LV remodeling, particularly septal thickening, is linked to higher blood pressure and adverse cardiovascular changes.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Essential hypertension can lead to left ventricular (LV) structural changes.
- Early detection of LV remodeling is vital for patient prognosis.
Purpose of the Study:
- To investigate the relationship between LV geometry and ambulatory blood pressure in untreated hypertensive patients.
- To identify specific patterns of LV remodeling associated with hypertension severity.
Main Methods:
- Echocardiography was used to assess LV mass and geometry in 669 untreated hypertensive subjects.
- 24-hour ambulatory blood pressure monitoring was performed on all participants.
- LV remodeling was defined by the ratio of wall thickness to internal diameter.
Main Results:
- 74% of subjects had normal LV mass; 26% showed LV remodeling.
- Asymmetric LV remodeling (isolated septal thickening) was associated with higher clinic and ambulatory blood pressure.
- This group also exhibited increased LV mass, peripheral resistance, and longer hypertension duration, with a decreased stroke index.
Conclusions:
- Asymmetric LV remodeling, specifically isolated septal thickening, is a significant finding in essential hypertension.
- This remodeling pattern correlates with poorer hemodynamic parameters and a longer history of hypertension.
- These findings underscore the importance of assessing LV structure for risk stratification in hypertensive patients.
Abstract:
Early identification of left ventricular (LV) structural changes may have an impact on the outlook of patients with essential hypertension. Of 669 untreated hypertensive subjects, 496 (74%) with normal LV mass at echocardiography (< 125 g/m2) were grouped according to normal LV geometry (n = 303; 61%), asymmetric LV remodeling due to isolated septal thickening (n = 111; 22%), asymmetric LV remodeling due to isolated posterior wall thickening (n = 5; 1%), or concentric LV remodeling due to septal and posterior wall thickening (n = 77; 16%). Remodeling was defined as twice the thickness of septum or posterior wall divided by the internal diameter at end diastole > 0.45. Twenty-four-hour noninvasive ambulatory blood pressure (BP) monitoring was performed in all subjects. Compared with subjects with normal LV geometry, those with asymmetric LV remodeling due to isolated septal thickening showed increased clinic BP (158/100 vs 153/97 mm Hg, both p < 0.05), mean daytime ambulatory BP (144/95 vs 138/90 mm Hg, both p < 0.01), mean nighttime ambulatory BP (128/80 vs 122/76 mm Hg, both p < 0.01), LV mass (99 vs 89 g/m2, p < 0.001), total peripheral resistance (1,881 vs 1,562 dynes s cm-5, p < 0.01) and known duration of hypertension (5.5 vs 3.6 years, p < 0.01) and decreased stroke index (39 vs 47 ml/m2, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)