Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data

Abstract

Aims To investigate differences in the prevalence of left ventricular (LV) and left atrial (LA) remodelling in hypertensive patients using various thresholds defined by international guidelines and data from the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and different indexation methods. Methods and results LV mass (LVM), relative ventricular wall thickness, and LA volume (LAV) were measured using 2D echocardiography in 612 healthy volunteers selected from the EMINCA study population and 306 adult Chinese patients with hypertension who were age- and gender-matched using propensity score-matched analysis. LVM and LAV values were indexed to body surface area (BSA), height2.7, height1.7, and height2 recommended by guidelines or investigators. Using a previously reported method, LV geometry was divided into normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. The prevalence of LV hypertrophy (LVH) and LV geometric patterns in hypertensive patients were compared using different thresholds and indexation methods. Echocardiographic thresholds from guidelines and healthy volunteers exhibited notable differences, particularly for LAV indexed to height2 and for LVM indexed to height1.7, which resulted in a significantly lower prevalence of LA dilatation and LVH in healthy volunteers. The total proportion of abnormal LV geometric patterns was significantly lower with thresholds from healthy volunteers than from guidelines when LVM was indexed to BSA, height1.7, and height2,7. Conclusion Using current echocardiographic thresholds and indexing methods recommended by guidelines may lead to significant misdiagnosis of LA dilatation, and abnormal LV geometry in Chinese patients with hypertension, and thresholds based on ethnic-specific normal echocardiographic reference values and an accurate indexing algorithm are warranted.

Prognostic implications of left ventricular hypertrophy defined by the thresholds from the international and Chinese guidelines

“…They subsequently proposed the Chinese thresholds to define LVH and LV geometry patterns. 10 These findings once again support the notion that ethnic-specific normal reference values to defined LV geometric patterns are needed.…”

99mTc-HFAPi imaging identifies early myocardial fibrosis in the hypertensive heart

“…In accordance with the American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) guidelines [17,18], LV geometric patterns in hypertensive patients are classified into four categories on the basis of the relationship between LV mass (LVM) and relative wall thickness (RWT) as follows: normal geometry: normal LVM and normal RWT; concentric hypertrophy: increased LVM and increased RWT; concentric remodeling: normal LVM and increased RWT; and eccentric hypertrophy: increased LVM and normal RWT [19].…”

Adenosine and Adenosine Receptors: Advances in Atrial Fibrillation

“…Sympathovagal activation is a strong modulator of AF. Interestingly, hypertension, sleep apnea and heart failure are known to induce sympathetic tone activation and specific atrial remodeling [ 1 , 173 , 174 , 175 , 176 ]. Moreover, all three AF risk factors also induce specific adenosinergic system remodeling.…”

“…Especially in patients suffering from essential hypertension, an A 2A R overexpression was described in PBMCs [ 139 ]. Because of the vasodilator effect of A 2A R, it was hypothesized that the A 2A R overexpression was a compensatory mechanism of high blood pressure [ 176 ]. However, the chronic release of adenosine in the peripheral cardiovascular system during high blood pressure may also induce atrial remodeling of adenosine receptors.…”