Geometric patterns of the left ventricle in relation to left atrial size among hypertensive patients at a tertiary hospital in South-South Nigeria

Abstract

Introduction: It is well established that left ventricular hypertrophy (LVH), determined by echocardiography, is a strong predictor of poor prognosis in cardiovascular disorders independent of the presence of traditional risk factors. The left ventricle undergoes morphological as well as functional alterations in its structure that impact adversely on the structure and overall function of the left atrium. The prevalence of left atrial (LA) enlargement in the hypertensive group was found to be 16% and 59% using LA linear diameter and LA maximum volume, respectively. Materials and Methods: The study was carried out on 200 adult hypertensive patients ≥18 years attending consultant cardiology outpatient clinics irrespective of blood pressure control, whether on antihypertensive medications or not. A transthoracic echocardiogram with ECG gating was performed according to established recommendations. Results: This study showed four different geometric patterns of left ventricular (LV) adaptation to chronic hypertension: concentric remodeling (CR) in 31.5%, concentric hypertrophy in 27.5%, eccentric hypertrophy in 12.5%, while 28.5% of the total population had normal LV geometry. LA size was discovered to be highest among patients with concentric patterns of hypertrophy compared to the eccentric geometric pattern. Findings suggest that LV pressure overload is more likely to impact on LA size than volume overload. This may be as a result of increased afterload in the left ventricle, leading to impairment of diastolic filling. Conclusion: Although CR of the LV is the most common type of geometric change among hypertensive patients, patients with dilated left atrium are more likely to have the concentric type of LVH than the eccentric type.