Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension

Abstract

The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass ("concentric remodeling"), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had "typical" hypertensive concentric hypertrophy (increase in both variables). Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was super-normal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular short-axis/long-axis ratio was positively related to stroke volume (r = 0.45, p less than 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume "underload" of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload. Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.

Effect of systemic hypertension on right ventricular morphology and function

“…Left ventricular hypertrophy is often associated with hypertension and is an adaptive mechanism to maintain or normalise wall stress, sometimes at the expense of diastolic and long-axis systolic function 5. This adaptive mechanism is associated with changes in left ventricular parameters and in chamber dimensions, geometry and function 6,7. These changes are progressive and can ultimately lead to heart failure with systolic and/or diastolic dysfunction 8.…”

Plasma levels of active extracellular matrix metalloproteinases 2 and 9 in patients with essential hypertension before and after antihypertensive treatment

“…The presence of left ventricular hypertrophy (LVH) was established when the left ventricular mass index was 4111 g/m 2 for men and 106 g/m 2 for women. 15 Ejection fraction was calculated according to Quinones et al 16 Cardiac output was calculated according to the following formula aortic annular cross-sectional area  flow velocity integral of left ventricular outflow  heart rate. 17 Systemic vascular resistance (SVR) was calculated as mean arterial blood pressure (1/3 pulse pressure+diastolic blood pressure)  80 divided by cardiac output, expressed in units of dynes Á second per centimeter 5 (normal range, 1170 7 270 dyn s/cm 5 ).…”

Microalbuminuria is associated with unfavourable cardiac geometric adaptations in essential hypertensive subjects

“…LV hypertrophy was considered present if LVMIϾ104 g/m 2 in women and Ͼ116 g/m 2 in men. 15,16 Normal geometry was considered when LV mass did not extend the above gender specific values. Concentric LV hypertrophy was considered present if relative wall thickness was Ͼ0.43 and eccentric LV hypertrophy when relative wall thickness was р0.43.…”