Serial Changes in Left Ventricular Mass in Hypertension: Prognostic Impact

Abstract

Among the several adverse changes in cardiovascular morphology and function that may occur in hypertension, increased left ventricular (LV) mass is of the utmost importance. Increased LV mass is a major predictor of cardiac and cerebrovascular events independently of the traditional cardiovascular risk factors such as blood pressure, diabetes, cholesterol levels, and smoking status [1–5]. The prevalence of ventricular arrhythmias is also substantially higher in hypertensive patients with LV hypertrophy than in those with no evidence of cardiac remodelling [6–8]. Although the mechanisms of the association between LV mass and prognosis are not completely clear, LV mass is generally considered a biological assay that reflects and integrates the long-term cumulative effect of several risk factors for cardiovascular disease. LV hypertrophy can be schematically divided into three main types: concentric, eccentric, and asymmetric. Longitudinal studies have suggested that the definition of LV geometry may be used to refine cardiovascular risk stratification in hypertensive subjects [9–13]. Such studies have found that, overall, the risk of developing cardiovascular disease was greater in patients with concentric remodelling than in those with normal LV geometry, and greater in patients with concentric LV hypertrophy than in those with eccentric LV hypertrophy [10–13]. However, since LV mass was greater in subjects with concentric remodelling than in those with normal geometry, and also greater in subjects with concentric LV hypertrophy than in those with eccentric LV hypertrophy, the independent prognostic impact of LV geometry was reduced or abolished completely due to the overwhelming prognostic value of the LV mass itself [9–13].