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[Left ventricular hypertrophy and left atrial morphology in untreated hypertensive patients]
G du Cailar1, J L Pasquié, J M Halimi
1Service de médecine interne G, hôpital Lapeyronie, Montpellier.
Insights
Arterial pressure is not the only factor in hypertension adaptation. Increased cardiac volume, not just high blood pressure, may influence heart changes in hypertensive patients with normal diastolic function.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiac Adaptation
Background:
- Arterial pressure is a key factor in hypertension, but its role in cardiac and vascular adaptation is not fully understood.
- Other factors, such as preload, may also influence these adaptations.
Purpose of the Study:
- To investigate factors beyond arterial pressure that contribute to cardiac and vascular adaptation in hypertension.
- To explore the relationship between left ventricular morphology, left atrial size, and diastolic function in hypertensive patients.
Main Methods:
- Echocardiography was used to categorize 55 untreated hypertensive patients and 39 controls based on relative wall thickness and left ventricular mass index.
- Systolic left atrial area (LA) and mitral flow velocities (E and A waves) were assessed using Doppler echocardiography.
Main Results:
- 63% of hypertensive patients had normal left ventricular anatomy.
- 16% showed concentric left ventricular hypertrophy and 14% eccentric left ventricular hypertrophy.
- Eccentric left ventricular hypertrophy was associated with increased left atrial area, suggesting volume overload may impact cardiac morphology.
Conclusions:
- Hypertension-induced cardiac remodeling is complex and influenced by factors beyond arterial pressure.
- Volume overload, indicated by increased cardiac volume and left atrial area, may play a significant role in modulating cardiac morphology in hypertensive individuals with preserved diastolic function.
Abstract:
The level of arterial pressure is not the sole determinant of cardiac and vascular adaptation to hypertension. In order to identify other factors (such as preload) we categorized by echocardiography, 55 never treated hypertensive patients and 39 age and gender-matched normal subjects, according to values of relative wall thickness and left ventricular mass index. Normal left ventricular anatomy was found in 63% hypertensives, whereas among hypertensives 7% had "concentric left ventricular remodeling", 16% concentric left ventricular hypertrophy and 14% had eccentric left ventricular hypertrophy. Systolic left atrial area (LA) was obtained from the four-chamber views. Mitral peak early diastolic (E) and late diastolic (A) flow velocity was assessed by Doppler. Because clinical characteristics such age and sex differed among the 5 groups only results of ANCOVA were reported (means +/- SD). [table: see text] We conclude that eccentric left ventricular hypertrophy may be associated with a parallel increase of left atrial area. Thus the association of an increase of cardiac volume in hypertensive patients with normal diastolic function suggest that volume overload may modulate the effect of arterial pressure on cardiac morphology.