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Prognostic value of left ventricular mass and geometry in systemic hypertension with left ventricular hypertrophy
P Verdecchia1, G Schillaci, C Borgioni
1Ospedale Generale Regionale Raffaello Silvestrini, Area Omogenea di Cardiologia e Medicina, Università di Perugia, Italy.
Insights
In hypertensive patients with left ventricular hypertrophy, higher left ventricular mass, not its geometric pattern, independently predicts cardiovascular events. This finding is crucial for risk stratification in hypertension management.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Systemic hypertension frequently leads to left ventricular hypertrophy (LVH).
- The prognostic significance of LVH patterns in hypertension requires further clarification.
- Echocardiography is essential for assessing LV mass and geometry.
Purpose of the Study:
- To evaluate the independent prognostic value of left ventricular (LV) mass and geometric patterns (concentric vs. eccentric hypertrophy) in hypertensive individuals with LVH.
- To determine if LV geometry influences cardiovascular event rates beyond established risk factors.
Main Methods:
- Prospective follow-up of 274 hypertensive patients with LVH (LV mass > 125 g/BSA) for a mean of 3.2 years.
- Echocardiography and ambulatory blood pressure (BP) monitoring were performed before treatment.
- LV geometry was classified as concentric or eccentric based on wall thickness to radius ratio.
Main Results:
- Higher average systolic ambulatory BPs were observed in concentric hypertrophy compared to eccentric hypertrophy.
- Left ventricular mass was slightly greater in concentric hypertrophy.
- Age > 60 and LV mass above the median (145 g/BSA) were significant adverse prognostic predictors.
- LV geometry and ambulatory BP were not independent predictors of cardiovascular events.
Conclusions:
- Left ventricular mass, rather than its geometric pattern (concentric vs. eccentric), provides significant independent prognostic information in hypertensive patients with LVH.
- LV mass is a critical marker for cardiovascular risk stratification in this population.
- Findings emphasize the importance of quantifying LV mass for personalized hypertension management.
Abstract:
To determine the independent prognostic significance of left ventricular (LV) mass and geometry (concentric vs eccentric pattern) in hypertensive subjects with LV hypertrophy at echocardiography, 274 subjects were followed for up to 8.7 years (mean 3.2). All patients had systemic hypertension and LV mass > or = 125 g/body surface area (BSA) and underwent ambulatory blood pressure (BP) monitoring and echocardiography before treatment. Eccentric and concentric hypertrophy were defined by the ratio between LV posterior wall thickness and LV radius at telediastole <0.45 and > or = 0.45, respectively. Age, sex ratio, body mass index, office BP and serum glucose, cholesterol, and triglycerides did not differ between the groups with eccentric (n=145) and concentric (n=129) hypertrophy. Average 24-hour daytime, and nighttime systolic ambulatory BPs were higher in concentric than in eccentric hypertrophy (all p <0.01). LV mass was slightly greater in concentric than in eccentric hypertrophy (157 vs 149 g/BSA, p <0.05). Endocardial and midwall shortening fraction were lower in concentric than in eccentric hypertrophy (96.5% vs 106.0% of predicted and 71.4% vs 89.7% of predicted, respectively; both p <0.01). The rate of major cardiovascular morbid events was 2.20 and 3.34 per 100 patient-years in eccentric and concentric hypertrophy, respectively (log rank test, p=NS). Age >60 and LV mass above median (145 g/BSA) were significant adverse prognostic predictors, while LV geometry (eccentric vs concentric hypertrophy) and ambulatory BP were not. The event rates per 100 patient-years were 1.38 and 3.98, respectively, in the patients with LV mass below and above median (age-adjusted relative risk 2.70; 95% confidence interval [CI] 1.03 to 6.63; p=0.015). In hypertensive subjects with established LV hypertrophy, LV mass, but not its geometric pattern, provides important prognostic information independent of conventional risk markers including office and ambulatory BP.