Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension

Institute of Clinical Medicine, University of Sassari, Italy.

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.

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				R. S. Amin, T. R. Kimball, J. A. Bean, J. L. Jeffries, J. P. Willging, R. T. Cotton, S. A. Witt, B. J. Glascock, and S. R. Daniels Left Ventricular Hypertrophy and Abnormal Ventricular Geometry in Children and Adolescents with Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., May 15, 2002; 165(10): 1395 - 1399. [Abstract] [Full Text] [PDF]

				J. J. G. De Lima, M. L. C. Vieira, L. F. Viviani, C. J. Medeiros, L. E. Ianhez, L. Kopel, J. L. de Andrade, E. M. Krieger, and S. G. Lage Long-term impact of renal transplantation on carotid artery properties and on ventricular hypertrophy in end-stage renal failure patients Nephrol. Dial. Transplant., April 1, 2002; 17(4): 645 - 651. [Abstract] [Full Text] [PDF]

				G. Mancia, S. Carugo, G. Grassi, A. Lanzarotti, R. Schiavina, G. Cesana, and R. Sega Prevalence of Left Ventricular Hypertrophy in Hypertensive Patients Without and With Blood Pressure Control: Data From the PAMELA Population Hypertension, March 1, 2002; 39(3): 744 - 749. [Abstract] [Full Text] [PDF]

				R. Sega, G. Trocino, A. Lanzarotti, S. Carugo, G. Cesana, R. Schiavina, F. Valagussa, M. Bombelli, C. Giannattasio, A. Zanchetti, et al. Alterations of Cardiac Structure in Patients With Isolated Office, Ambulatory, or Home Hypertension: Data From the General Population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study) Circulation, September 18, 2001; 104(12): 1385 - 1392. [Abstract] [Full Text] [PDF]

				J. N. Bella, V. Palmieri, J. E. Liu, D. W. Kitzman, A. Oberman, S. C. Hunt, P. N. Hopkins, D.C. Rao, D. K. Arnett, and R. B. Devereux Relationship Between Left Ventricular Diastolic Relaxation and Systolic Function in Hypertension: The Hypertension Genetic Epidemiology Network (HyperGEN) Study Hypertension, September 1, 2001; 38(3): 424 - 428. [Abstract] [Full Text] [PDF]

				V. Di Bello, R. Pedrinelli, D. Giorgi, A. Bertini, M. T. Caputo, A. Cioppi, E. Talini, M. Leonardo, G. Dell'Omo, M. Paterni, et al. Microalbuminuria, Pulse Pressure, Left Ventricular Hypertrophy, and Myocardial Ultrasonic Tissue Characterization In Essential Hypertension Angiology, March 1, 2001; 52(3): 175 - 183. [Abstract] [PDF]

				A. H. El-Gharbawy, V. S. Nadig, J. M. Kotchen, C. E. Grim, K. B. Sagar, M. Kaldunski, P. Hamet, Z. Pausova, D. Gaudet, F. Gossard, et al. Arterial Pressure, Left Ventricular Mass, and Aldosterone in Essential Hypertension Hypertension, March 1, 2001; 37(3): 845 - 850. [Abstract] [Full Text] [PDF]

				J. Sundstrom, L. Lind, B. Vessby, B. Andren, A. Aro, and H. O. Lithell Dyslipidemia and an Unfavorable Fatty Acid Profile Predict Left Ventricular Hypertrophy 20 Years Later Circulation, February 13, 2001; 103(6): 836 - 841. [Abstract] [Full Text] [PDF]

				S. Perlini, M. L. Muiesan, C. Cuspidi, L. Sampieri, B. Trimarco, G. P. Aurigemma, E. Agabiti-Rosei, and G. Mancia Midwall Mechanics Are Improved After Regression of Hypertensive Left Ventricular Hypertrophy and Normalization of Chamber Geometry Circulation, February 6, 2001; 103(5): 678 - 683. [Abstract] [Full Text] [PDF]

				P. Segers, N. Stergiopulos, and N. Westerhof Quantification of the Contribution of Cardiac and Arterial Remodeling to Hypertension Hypertension, November 1, 2000; 36(5): 760 - 765. [Abstract] [Full Text] [PDF]

				M. J. Roman, A. Ganau, P. S. Saba, R. Pini, T. G. Pickering, and R. B. Devereux Impact of Arterial Stiffening on Left Ventricular Structure Hypertension, October 1, 2000; 36(4): 489 - 494. [Abstract] [Full Text] [PDF]

				S. Denslow Constraints on cardiac hypertrophy imposed by myocardial viscosity J Appl Physiol, September 1, 2000; 89(3): 1022 - 1032. [Abstract] [Full Text] [PDF]