Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

Verdecchia, Paolo; Angeli, Fabio; Bartolini, Claudia; Garofoli, Marta; Aita, Adolfo; Poltronieri, Cristina; Pinzagli, Maria Gabriella; Valecchi, Francesca; Martone, Stefania; Ramundo, Elisa; Turturiello, Dario; Reboldi, Gianpaolo

doi:10.1161/jaha.117.005948

Cited by 14 publications

(7 citation statements)

References 37 publications

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“…Whether abnormal LV geometric patterns (i.e. LV concentric remodelling, eccentric and concentric LVH) provide independent prognostic information beyond that conveyed by LVM remains uncertain [7]. It has been shown that these patterns differ from each other in terms of clinical features, comorbidities, hemodynamic profile, LV myocardial function, plasma volume and cardiovascular outcomes (i.e.…”

Section: Introductionmentioning

confidence: 99%

Myocardial strain and left ventricular geometry: a meta-analysis of echocardiographic studies in systemic hypertension

Tadić

Sala

Carugo

et al. 2021

Journal of Hypertension

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Aim: Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still limited. Thus, we performed a systematic meta-analysis of 2D/3D speckle-tracking studies in order to provide an updated comprehensive information on this topic. Methods: The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to 31 January 2021. Studies were identified by using MeSH terms and crossing the following search items: ‘myocardial strain’, ‘left ventricular mechanics’, ‘speckle tracking echocardiography’, ‘systolic dysfunction’, ‘hypertensive heart disease’, ‘left ventricular hypertrophy’, left ventricular remodeling”, ‘concentric hypertrophy’, ‘eccentric hypertrophy’. Results: Overall, data of 267 normotensive controls and 712 hypertensive patients (234 normal geometry, 97 LV concentric remodeling, 176 eccentric LVH, and 205 concentric LVH) from eight studies were considered. Pooled ejection fraction was similar in normotensives and in the whole group of hypertensive patients: (SMD 0.037 ± 0.05, confidence interval (CI): 0.14/0.07, P = 0.51) as well as in hypertensive subgroups. LVMI, and E/e’ gradually increased from hypertensive patients with normal geometry and concentric remodeling, to patients with eccentric and concentric LVH. LV global longitudinal strain (GLS) was lower in all hypertensive groups compared with normotensive controls, in particular, in the eccentric (SMD 1.14 ± 0.22, CI: 0.69/1.59, P < 0.0001) and concentric LVH group (SMD 1.37 ± 0.21, CI: 0.95/1.79, P < 0.0001). The meta-analysis restricted to hypertensive patients showed that GLS gradually deteriorated from hypertensive patients with normal LV geometry, across those with concentric remodeling, to participants with eccentric and concentric LVH (−19.5 ± 0.6 versus −18.8 ± 0.73 versus −17.6 ± 0.66 versus −16.5 ± 0.6%, P < 0.001 for trend). Statistical significance was reached when GLS of the concentric and eccentric LVH group but not the concentric remodeling was compared with the normal geometry one. Conclusion: The present meta-analysis confirms that GLS performs better than ejection fraction in identifying systolic dysfunction in the hypertension setting. More importantly, it suggests that this occurs in patients with altered LV structure and geometry, such as LVH.

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Section: Introductionmentioning

confidence: 99%

Myocardial strain and left ventricular geometry: a meta-analysis of echocardiographic studies in systemic hypertension

Tadić

Sala

Carugo

et al. 2021

Journal of Hypertension

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“… 18 In an initially untreated large sample of subjects with hypertension, those with LV dilation, regardless of the hypertrophy pattern, experienced a worse prognosis compared with subjects without LV dilation. 19 20 The authors of the Dallas study suggested to subdivide eccentric and concentric LVH into two subgroups based on the presence or absence of LV dilation. 16 In this study, subjects with LV dilation were at higher risk of cardiovascular death and heart failure compared with those without LV dilation.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular chamber dilation and filling pressure may help to categorise patients with type 2 diabetes

Zoppini

Bergamini

Bonapace

et al. 2018

BMJ Open Diab Res Care

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BackgroundType 2 diabetes may alter cardiac structure and function. Many patients with type 2 diabetes have diastolic dysfunction with preserved ejection fraction (EF). Recently, this latter measure was criticised. Thus, this research looked at the impact of left ventricular end-diastolic volume and E/e′ ratio variations in patients with type 2 diabetes and preserved EF with the aim to recognise different clinical phenotypes.MethodsIn this cross-sectional study, we evaluated 176 men affected by type 2 diabetes with transthoracic echocardiography. All subjects have preserved EF (>50%). Patients were stratified into four groups based on the median value of both left ventricular end-diastolic volume and E/e′ ratio, and the clinical variables were registered. The independent predictors associated with the groups were analysed by a multinomial logistic regression model.ResultsDiabetes duration, age, estimated glomerular filtration rate and antihypertensive treatments were significantly different among the groups as were EF, left atrial volume index (LAVI), E/A, septum thickness and s′ mean wave. Multinomial regression analysis showed that the groups significantly differed for age, diabetes duration, EF, LAVI, septum thickness and s′ mean wave. The main result of this study was that patients with higher left ventricular volume and higher E/e′ ratio (group 2) showed the worse clinical profile.ConclusionsOur study might suggest that variations of left ventricular end-diastolic volume along with E/e′ ratio variations, even in the normal range, may allow to recognise phenotypes of patients with type 2 diabetes with worse clinical characteristics. This finding should be tested in prospective studies to assess the predictive roles of these phenotypes.

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“…Than 2 groups were also formed: the first one was the hypertrophic type -eccentric and concentric hypertrophy, indicating an unfavorable, and the second one was non-hypertrophic type with normal geometry and concentric remodeling that was regarded as favorable. Such a categorization was done in accordance with contemporary international data [6][7][8].…”

Section: Methodsmentioning

confidence: 99%

Combined influence of diabetes mellitus and obesity on left ventricle remodeling in hypertensive patients

Шелест¹,

Kovalova²,

Шелест³

et al. 2021

ZMJ

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The aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients. Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA. Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson's contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05). Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy.

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Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

Cited by 14 publications

References 37 publications

Myocardial strain and left ventricular geometry: a meta-analysis of echocardiographic studies in systemic hypertension

Myocardial strain and left ventricular geometry: a meta-analysis of echocardiographic studies in systemic hypertension

Left ventricular chamber dilation and filling pressure may help to categorise patients with type 2 diabetes

Combined influence of diabetes mellitus and obesity on left ventricle remodeling in hypertensive patients

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