Abstract
The purpose of this study is to investigate the influence of the systemic hemodynamics, plasma renin activity (PRA) and serum concentrations of aldosterone (CA) in the development of left ventricular (LV) geometry in patients with EH. 122 patients with I - III (JNC-VI) (71 men and 51 women, mean age 49.6 ±1.6 years) were examined by 2-D guided M-mode Echocardiography and Radiocardiography with 131I -albumin. PRA and CA were measured by radioimunoassay. Forty-eight normotensive healthy subjects served as controls. Correlation analysis was performed to detect the influence of the hemodynamic and hormonal factors in development of the distinct patterns of LV geometry. Correlation analyses revealed that BP promotes to the development of the LV concentric remodeling. Systolic BP was correlated with posterior wall thickness (PWT) and septal wall thickness (SWT) (r=0.5,P< 0.05; r=0.6, P<0.05, respectively). Diastolic BP was correlated with SWT (r=0.6, P<0.05). Cardiac index (CI) and total peripheral resistance (TPR) were important factors for development of concentric LV hypertrophy (LVH). Correlation analyses revealed that CI was significantly associated with PWT (r=-0.8, P<0.01), SWT (r=-0.7, P<0.01) and LV mass index (LVMI) (r=-0.7, P<0.05). There was found the correlation between the TPR and SWT, and LVMI (r=0.7, P<0.05, each). Pulmonary blood volume (PBV) and circulating blood volume (CBV) play an important role in the development of the eccentric LVH. There was a correlation between PBV and LV end-diastolic diameter (EDD) and LVMI (r=0.8, p<0.001, each) and also between CBV and EDD (r=0.6, P< 0.05) and LVMI (r=0.5, P<0.05). PRA plays an important role for development of concentric LVH. There was observed a correlation between PRA and PWS, SWT (r=0.6, P<0.05, each) and LVMI (r= 0.7, P<0.05). In concentric LVH PRA was significantly increased as compared with normal subjects (nonactive renin 3.1 ± 0.6 vs. 5.3 ±0.3 ng/ml/hr, p< 0.05). CA promotes to the development of the eccentric LVH; there was a correlation with EDD (r=0.5, P<0.05) and LVMI (r=0.6, P<0.05). CA was significantly elevated in patients with eccentric LVH (269.0 ±18.8 vs. 185.0 ± 8.0 ng/ml/hr, P<0.05). Fundamental hemodynamic and hormonal mechanisms of structural adaptation of the LV were established and the concept of multifactoral genesis of LV remodeling was grounded in patients with EH.
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