Abstract
Although in cross-sectional studies left ventricular mass (LVM) which exceeds that predicted by work load (inappropriate LVM [LVM inappr ]), but not absolute LVM or LVM index, is inversely related to LV ejection fraction (EF), whether LVM inappr (%observed/predicted LVM) accounts for decreases in EF is unclear. In 168 mild-to-moderate hypertensives treated for 4 months, using echocardiography, we assessed whether on-treatment decreases in absolute LVM, LVM index (LVMI) or LVM inappr are associated with on-treatment changes in EF. Although in patients with an LVMI>51g/m 2.7 (n=112)(change in LVMI=-13.7±1.2g/m 2.7 , p<0.0001), but not in patients with an LVMI≤51g/m 2.7 (n=56)(change in LVMI=1.3±1.7g/m 2.7 ) LVMI decreased with treatment; treatment failed to increase EF in either group (1.2±1.0% and 2.7±1.4% respectively). In contrast, in patients with inappropriate LV hypertrophy (LVH) (LVM inappr >150%, n=33) LVM inappr decreased (-32±4%, p<0.0001) and EF increased (5.0±1.8%, p<0.0001) after treatment, whilst in patients with a LVM inappr ≤150% (n=135), neither LVM inappr (-0.5±2%), nor EF (0.9±0.9%) changed with therapy. With adjustments for LV wall stress and other confounders, whilst on-treatment decreases in LVM or LVMI were weakly related to an attenuated EF (partial r=0.17, p<0.05), on-treatment decreases in LVM inappr were strongly related to increases in EF (partial r=-0.38, p<0.0001)(p<0.0001, comparison of partial r values) even after further adjustments for LVM or LVMI. In conclusion, decreases in LVM inappr but not LVM or LVMI are strongly related to on-treatment increases in EF. LVH can therefore be viewed as a compensatory change that preserves EF, but when in excess of that predicted by stroke work, as a pathophysiological process accounting for a reduced EF.
Published Version
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