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Left ventricular geometry as an independent predictor for extracardiac target organ damage in essential hypertension
Y Shigematsu1, M Hamada, T Ohtsuka
1The Second Department of Internal Medicine, Ehime University School of Medicine, Japan.
Insights
Left ventricular hypertrophy (LVH) can lead to extracardiac organ damage. Concentric LVH, compared to eccentric LVH, is associated with more severe damage, indicating geometry is a key factor in hypertension outcomes.
Area of Science:
- Cardiology
- Hypertension Research
- Organ Damage Studies
Background:
- Left ventricular hypertrophy (LVH) is a known cardiovascular risk factor.
- The role of left ventricular geometry in predicting extracardiac target organ damage in essential hypertension remains unclear.
Purpose of the Study:
- To investigate whether left ventricular geometry is an independent predictor of extracardiac target organ damage in essential hypertension.
- To compare extracardiac target organ damage between patients with concentric and eccentric LVH.
Main Methods:
- Patients were classified into concentric LVH (n=27) and eccentric LVH (n=50) groups based on relative wall thickness.
- Age and left ventricular mass index were matched between groups.
- Retinal funduscopic grade and serum creatinine levels were measured as indicators of extracardiac target organ damage.
Main Results:
- Patients with concentric LVH showed more severe hypertensive retinopathy and renal involvement compared to those with eccentric LVH.
- Extracardiac target organ damage was significantly higher in the concentric LVH group.
- Higher total peripheral resistance was observed in concentric LVH patients and correlated with retinal and renal damage.
Conclusions:
- Left ventricular geometry, specifically concentric versus eccentric patterns, independently stratifies extracardiac target organ damage in essential hypertension.
- Echocardiographically determined geometry provides additional prognostic information beyond the degree of LVH.
- Concentric LVH is associated with worse systemic hemodynamics and greater organ damage in hypertensive patients.
Abstract:
Left ventricular hypertrophy (LVH) is an independent cardiovascular risk factor. It has not been established, however, whether left ventricular geometry is an independent predictor of extracardiac target organ damage in essential hypertension. Study groups were classified according to relative wall thickness: 27 patients with concentric LVH and 50 patients with eccentric LVH. Age and left ventricular mass indexes of two groups were matched. As indexes of extracardiac target organ damage, retinal funduscopic grade, and serum creatinine level were measured. The severity of hypertensive retinopathy and the renal involvement were more severe in patients with concentric LVH than in patients with eccentric LVH. Extracardiac target organ damage was consistently higher in patients with concentric LVH than in those with eccentric LVH. Systemic hemodynamics paralleled ventricular geometric patterns, with higher peripheral resistance and lower aortic compliance in patients with concentric LVH, whereas end-diastolic volumes and stroke volumes were higher in patients with eccentric LVH than in patients with concentric LVH. In addition, total peripheral resistance was related to retinal fundoscopic grade (r = 0.41, P < .01), and serum creatinine level (r = 0.28, P < .05). Even in the presence of an identical degree of LVH, echocardiographically determined left ventricular geometry may provide a further independent stratification of extracardiac target organ damage in essential hypertension.