Inappropriateness of ventricular hypertrophy is important as a determinant of BNP but not of diastolic filling in untreated hypertensive patients

Abstract

Echocardiographically determined inappropriateness of left ventricular mass (LVM) is an independent risk factor for cardiovascular events. Although LV hypertrophy is associated with an increase in the plasma brain natriuretic peptide level and decreased LV diastolic filling, it is unknown whether the inappropriateness of LVM affects them. We studied 77 untreated hypertensive patients (49 men, 28 women, aged 59+/-12 years). The plasma brain natriuretic peptide level was measured, in addition to routine echo Doppler indexes of LV geometry and function. The appropriateness of LVM to cardiac workload was evaluated by the ratio of the observed LVM to the value predicted for individual sex, stroke work and height(2.7) (oLVM/pLVM). Multivariate analysis showed that the plasma brain natriuretic peptide level increased with LVM index but decreased when oLVM/pLVM increased. The ratio of the peak early diastolic flow velocity of mitral flow to the peak early diastolic velocity of mitral annulus (E/E') correlated not only with oLVM/pLVM but also with the LVM index (r=0.30, P<0.05; r=0.37, P<0.05, respectively). However, when a multiple stepwise regression analysis was carried out, only LVM index was determined to be a significant correlate of the E/E' ratio, indicating that the inappropriateness of LVM does not affect the E/E' ratio in hypertensive patients. Brain natriuretic peptide levels are influenced not only by the extent of LV hypertrophy but also by the inappropriateness of hypertrophy in untreated hypertensive patients. Diastolic filling is mostly affected by the extent of LV hypertrophy and not by the appropriateness of hypertrophy.