Left Ventricular Geometric Patterns Research Articles

Relationship between electrocardiographic voltage and geometric patterns of left ventricular hypertrophy in patients with essential hypertension.

To assess whether we could predict left ventricular (LV) geometric patterns on echocardiography from voltages in standard electrocardiograms (ECG) in patients with essential hypertension, standard 12-lead ECG and echocardiograms were recorded in 106 consecutive, untreated patients (50+/-11 yr old) with essential hypertension. Subjects were assigned to the following four groups based on relative wall thickness (RWT) and LV mass index (LVMI) as determined by echocardiography: a normal geometry group (n = 44), a concentric remodeling group (increased RWT and normal LVMI, n = 10), an eccentric hypertrophy group (increased LVMI and normal RWT, n = 23), and a concentric hypertrophy group (increased RWT and LVMI, n = 29). The following ECG variables were determined: Sokolow-Lyon voltage (SV1 = RV5: SL), Cornell voltage (RaVL + SV3: CN), sum of 12-lead QRS voltage (12-lead sum), and RV6/RV5 ratio (RV6/V5). LVMI correlated with SL, CN, and 12-lead sum, but not with RV6/V5 in the study group as a whole. The concentric hypertrophy group showed increased voltages for all ECG variables except RV6/V5. The concentric remodeling group showed increased voltages for SL and 12-lead sum, but a decreased RV6/V5 ratio. In contrast, the eccentric hypertrophy group had increased voltage only for the 12-lead sum. The combination of SL, RV6/V5, and CN showed modest sensitivity and specificity in the diagnosis of concentric remodeling, concentric hypertrophy, and normal geometry, but not in the diagnosis of eccentric hypertrophy. Conventional ECG criteria can predict LVMI, but not LV geometry in the patients with essential hypertension. The combination of SL, CN, and RV6/V5 is useful in differentiating the four LV geometric patterns seen in essential hypertension.

Factors Influencing Left Ventricular Mass in Salt Sensitive and Salt Resistant Essential Hypertensive Patients

To investigate whether salt sensitivity is associated with differences in left ventricular mass or geometry, salt sensitivity testing and Doppler echocardiography was performed in 30 essential hypertensive patients (7 women and 23 men) with mean age 43+/-9 years. Salt sensitivity was defined as a 10% increase or more in 24-h blood pressure (24hBP) when going from low to high dietary sodium intake based on a single test. Eight patients were characterized as salt sensitive and 22 as salt resistant. At baseline, there was no difference in casual blood pressure (156/103+/-17/9 vs 158/100+/-18/11 mmHg) or 24hBP (152/ 90+/-25/15 vs 159/89+/-19/8 mmHg), in duration of hypertension (5+/-4 vs 4+/-3 years), daily sodium excretion (144+/-68 vs 171+/-68 mmol), left ventricular mass (LVM) (212+/-45 vs 246+/-52 g) or left ventricular relative wall thickness (RWT) between the salt sensitive and salt resistant groups of patients. In the total study population, increased RWT was found in 17 patients, and increased LVM in 10 patients. In only 10 patients were both these variables normal. Left ventricular geometric pattern did not differ between the salt sensitive and salt resistant groups. LVM and RWT were significantly correlated with 24hBP (r = 0.57 and 0.51, respectively; both p < 0.01). Significant correlation was also found between LVM and casual blood pressure, blood volume, body surface area, serum creatinine and albuminuria (r = 0.53, 0.60, 0.54, 0.54 and 0.43, respectively; all p < 0.01). In multiple regression analysis, 24hBP and blood volume were identified as independent predictors of LVM (R = 0.51, p < 0.001). increased RWT or LVM is common in both salt sensitive and salt resistant essential hypertensive patients. Salt sensitivity status based on a single test does not influence left ventricular hypertrophy or geometry. Twenty-four-hour blood pressure is related to increased RWT and LVM.

The Relationship of Hyperinsulinemic State to Left Ventricular Hypertrophy, Microalbuminuria, and Physical Fitness in Borderline and Mild Hypertension

The relationship of the hyperinsulinemic state to left ventricular hypertrophy, left ventricular geometric patterns, microalbuminuria, and physical fitness were studied in 52 middle-aged unmedicated men with borderline and mild hypertension. Left ventricular mass index and relative wall thickness were assessed by echocardiography. Physical fitness was determined by symptom-limited maximal treadmill stress testings. The urinary concentration of microalbumin and C-peptide was measured in 24-h urine samples by radioimmunoassey. The 24-h urinary C-peptide excretion rate was correlated with left ventricular mass index (r = 0.46), relative wall thickness (r = 0.41), treadmill time (r = −0.35), normalized treadmill time (r = −0.52), systolic blood pressure at peak exercise (r = 0.29), and 24-h urinary microalbumin excretion (r = 0.48). Stepwise multiple regression analysis identified the left ventricular mass index, the 24-h urinary albumin excretion, and the normalized treadmill time as variables in the equation for the 24-h urinary C-peptide excretion. Thus, the hyperinsulinemic state is related to left ventricular hypertrophy, microalbuminuria, and impaired physical fitness in patients with borderline and mild hypertension.

Left ventricular hypertrophy and arterial hypertrophy.

In the most recent WHO recommendations of 1996 it was reiterated that the classification of HT still remains based on the actual BP figures but also on the importance of target organ lesions. Thus the study of cardiac and vascular function and in particular the presence of hypertrophy or remodeling is of importance. A limited number of studies have examined the prevalence, the association and the correlation between modifications and remodeling in the heart and in the vasculature. It is important to distinguish compliance vessels such as the carotid from resistance vessels such as the radial. For compliance vessels the prevalence of cardiac and vascular hypertrophy are nearly identical being around 5% for normotensive subjects and around 12% for hypertensive subjects. This prevalence of thickening in the intima-media is more evident in subjects with left ventricular hypertrophy (LVH). The left ventricular geometric pattern is also an element to take into account. The presence of concentric remodeling of the left ventricle without LVH has already been associated with an increase in intima-media thickness (IMT). When there is an LVH this IMT is similar in severity to the LVH and in particular concentric. For resistance vessels such as the radial artery the number of studies is limited but a significant correlation between left ventricular mean wall thickness and common carotid artery distensibility and compliance has been found. There is also a significant correlation between the radial median lumen ratio and the relative wall thickness but this correlation disappears when age and systolic BP are taken into account. Thus for this type of vessel it is too early to conclude the elements contributing to structural changes. The determinant factors for these structural changes in the heart and the carotid arteries associated with hypertension are certainly multiple be they haemodynamic, hormonal or genetic. The observation establishing an association between anomalies at cardiac and vascular level may have undoubted diagnostic, prognostic and therapeutic implications which are all intimately related and which require refinement and confirmation.

Prospective studies on left ventricular geometric patterns and exercise tolerance in unmedicated men with borderline and mild hypertension.

This study was designed and conducted to assess the clinical significance of left ventricular geometric patterns and physical fitness in subjects with untreated borderline and mild hypertension. Symptom-limited maximal treadmill stress testings and echocardiographic examinations were administered to 192 previously unmedicated men. Left ventricular geometric patterns were determined by the combined criteria of left ventricular mass index and relative wall thickness. Subjects whose left ventricular mass index was < 125 g/m2 were followed up for more than 3 years. Normalized treadmill time was lower and pressure rate products at peak exercise were higher in patients with concentric hypertrophy than in those with normal geometry. Of the 77 patients who revealed left ventricular mass index at baseline < 125 g/m2 and who were successfully followed without medication for more than 3 years, 18 demonstrated concentric hypertrophy at the final follow-up examination. During the follow-up period, these 18 patients had significant further augmentation of concentric geometric features, significant decreases in both cardiac output and normalized treadmill time, and significant increases in casual blood pressure and total peripheral resistance compared with those at baseline. Patients with concentric hypertrophy exhibited slightly but significantly impaired levels of physical fitness and cardiac work efficiency, and the progression of concentric hypertrophy demonstrated further impairments of these conditions. Therefore, not only lowering blood pressure, but also improving left ventricular hypertrophy, cardiovascular hemodynamics, and physical fitness might be required in patients with concentric hypertrophy.

Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults

Objectives. The present study sought to determine whether conduit artery structure and function vary according to the pattern of left ventricular adaptation to hypertension.Background. Although left ventricular geometric pattern has been shown to predict cardiovascular events in hypertension, the arterial status in patients with the different patterns is unknown.Methods. We evaluated arterial structure and function by carotid ultrasound and applanation tonometry in 271 unmedicated hypertensive patients classified by echocardiography as having normal ventricular geometry (n = 176), concentric remodeling (n = 54), concentric hypertrophy (n = 16) or eccentric hypertrophy (n = 25).Results. All groups were similar in age, gender distribution and body size. Patients with concentric and eccentric hypertrophy had similar blood pressures (mean 173/100 and 171/99 mm Hg, respectively) and left ventricular mass, but compared with patients with normal left ventricular geometry and concentric remodeling, only those with concentric hypertrophy had increased arterial wall thickness (0.96 ± 0.20 vs. 0.80 ± 0.18 mm, p< 0.05), end-diastolic diameter (6.38 ± 0.97 vs. 5.76 ± 0.87 mm, p < 0.05), cross-sectional area (22.1 ± 5.71 vs. 16.6 ± 5.4 mm2, p < 0.05) and elastic modulus (713 ± 265 vs. 471 ± 241 dynes/cm2 × 10−6, p < 0.05). Patients with concentric remodeling and eccentric hypertrophy had similar values for these measures (0.85 ± 0.22 and 0.89 ± 0.21 mm, 5.67 ± 0.77 and 6.04 ± 0.44 mm, 17.2 ± 5.4 and 19.7 ± 5.9 mm2, 558 ± 263 and 614 ± 257 dynes/cm2 × 10−6, respectively), despite lower systolic blood pressures in the former group (156/94 mm Hg, p < 0.001). The prevalence of plaque was comparable in patients with concentric (56%) and eccentric (42%) hypertrophy and significantly greater in those with normal geometry (21%).Conclusions. Among patients with generally mild, uncomplicated systemic hypertension, arterial structure and function are most abnormal when concentric left ventricular hypertrophy is present and may contribute to the more adverse outcome associated with this geometric pattern.

Relation of Arterial Structure and Function to Left Ventricular Geometric Patterns in Hypertensive Adults

Relation of Arterial Structure and Function to Left Ventricular Geometric Patterns in Hypertensive Adults

Left ventricular geometric patterns after one year of antihypertensive treatment

Left ventricular geometric patterns after one year of antihypertensive treatment

Hyperinsulinemia and left ventricular geometry in a work-site population in Japan.

The present study was designed to test whether hyperglycemia or hyperinsulinemia influences left ventricular mass and geometry. An echocardiogram and 75-g oral glucose tolerance test were performed in 210 normotensive and 180 mildly to moderately hypertensive male workers in a bus company who were free from cardiac diseases and were not taking medication for hypertension and diabetes mellitus. When we divided subjects into four groups according to the left ventricular geometric pattern using left ventricular mass index of 110 g/m2 and relative wall thickness (ratio of 2 x posterior wall thickness to end-diastolic left ventricular diameter) of 0.44, body mass index and systolic blood pressure were higher in those with concentric hypertrophy and eccentric hypertrophy. In addition, hemoglobin A(Ic) level and the sum of fasting and 2-hour postload serum glucose levels were higher in subjects with concentric hypertrophy. In subjects without diabetes mellitus (n=336), 2-hour postload serum insulin level and the sum of fasting and 2-hour postload serum insulin levels tended to be higher in those with concentric hypertrophy and concentric remodeling. In multiple regression analysis, the sum of glucose levels (or hemoglobin A(Ic) level) in all subjects and the sum of insulin (or 2-hour postload insulin) levels in subjects without diabetes mellitus significantly correlated with relative wall thickness, independent of age, systolic blood pressure, and body mass index. Neither glucose nor insulin levels correlated with left ventricular mass index. Our results suggest that hyperglycemia and hyperinsulinemia may promote concentric changes in the left ventricle in normotensive and mildly to moderately hypertensive men.

Left Ventricular Geometric Patterns of Dippers and Non-Dippers in Essential Hypertension

Left Ventricular Geometric Patterns of Dippers and Non-Dippers in Essential Hypertension

Effect of age on left ventricular geometric patterns in hypertensive patients

To investigate the effect of age on left ventricular structure and geometry in hypertensive patients, we studied the relationship between age and echocardiographic variables in patients with uncomplicated essential hypertension. We divided 168 patients with hypertension into three groups according to age: young (<40 years), middle-aged (40-59 years) and an elderly group (> or = 60 years). They were further categorized according to relative wall thickness and the left ventricular mass index. We then evaluated the prevalence of left ventricular geometric patterns in these patients according to age. The left ventricular end-diastolic dimension decreased with age, both in normotensive control subjects and in hypertensive patients. The magnitude of this decrease was similar for both. The relative wall thickness and left ventricular mass index were greater in the hypertensive patients than in the normotensive control subjects, and these increased with age both in the controls and the hypertensives. The differences between normotensives and hypertensives in these variables remained unchanged with age. The prevalence of a normal left ventricle (normal relative wall thickness and left ventricular mass index) in the hypertensive patients decreased with age. Conversely, the prevalence of concentric remodeling (increased relative wall thickness with normal left ventricular mass index) and concentric hypertrophy (increased relative wall thickness and left ventricular mass index) increased with age. These results demonstrate that age significantly affects left ventricular structure both in normotensive control subjects and in hypertensive patients. Thus, the differences in left ventricular geometric patterns with age may have important implications in assessing left ventricular structure and geometric patterns in hypertensive patients.

B11 - Effect of age left ventricular geometric patterns in hypertensive patients

B11 - Effect of age left ventricular geometric patterns in hypertensive patients

Prognosis of left ventricular geometric patterns in the Framingham heart study

The goal of this study was to determine the incremental prognostic value of left ventricular geometric patterns beyond that provided by cardiovascular disease risk factors, including left ventricular mass. Left ventricular geometry may be classified into the following four mutually exclusive groups on the basis of left ventricular mass and relative wall thickness: concentric hypertrophy (increased mass and increased relative wall thickness), eccentric hypertrophy (increased mass and normal relative wall thickness), concentric remodeling (normal mass and increased relative wall thickness) and normal geometry (normal mass and normal relative wall thickness). The prognosis associated with these patterns in a population-based sample is not known. Proportional hazards regression models were used to evaluate the prognostic importance of left ventricular geometry in 3,216 subjects in the Framingham Heart Study who were > or = 40 years old and free of clinically apparent cardiovascular disease, after adjustment for traditional cardiovascular risk factors and left ventricular mass. The follow-up period was 8 years. Subjects with concentric hypertrophy had the worst prognosis, followed by those with eccentric hypertrophy, concentric remodeling and normal geometry. Subjects with concentric hypertrophy also had the highest left ventricular mass. The association between type of geometry and prognosis was largely attenuated by adjustment for baseline differences in left ventricular mass. The odds ratio for incident cardiovascular disease in subjects with concentric hypertrophy compared with those who had normal geometry was 1.3 (95% confidence interval [CI] 0.8 to 2.1) in men and 1.2 (95% CI 0.6 to 2.3) in women after adjustment for other cardiovascular risk factors, including left ventricular mass. In a population-based sample of subjects without cardiovascular disease, knowledge of left ventricular geometry provided little prognostic information beyond that available from left ventricular mass and traditional cardiovascular risk factors.

Evaluation of the Heart and Arterial Tree in Hypertension

Measurement of left ventricular and arterial structure and function using ultrasound provides information about cardiovascular adaptation to human hypertension. Standardized methods of M-mode, two-dimensional, and Doppler echocardiography and arterial ultrasonography are outlined in this review. Their use can detect a spectrum of left ventricular geometric patterns (concentric and eccentric hypertrophy and concentric remodeling), altered left ventricular contractility, pump function, and filling, and arterial hypertrophy and atherosclerosis. Detection of these abnormalities helps to stratify the level of risk and identify pathophysiological patterns in hypertensive patients.

What Is Normal Blood Pressure? Comparison of Ambulatory Pressure Level and Variability In Patients With Normal or Abnormal Left Ventricular Geometry

To assess the level and pattern of normal ambulatory blood pressure (ABP) using a non-BP standard to identify normality, we examined the level and variability of ABP during the waking day, at work, at home, and during sleep and looked at physician and technician BP measurements in 191 adults whose left ventricular (LV) geometry was classified by echocardiography. Clinic BPs were similar in the 120 subjects with normal LV geometry and the 35 subjects with concentric LV remodeling. Pressures were only modestly higher in the 15 subjects with concentric LV hypertrophy than in the 21 with eccentric hypertrophy. In contrast, these subject groups differed with regard to their ABPs during the waking hours, at home, and especially at work. However, no difference in BP variability, as assessed by the standard deviation of awake systolic or diastolic BP, existed among the subject groups identified by LV geometric patterns. Comparison of patients with concentric LV hypertrophy, the LV pattern associated with the worst prognosis, with normotensive subjects with normal LV geometry suggests that awake ABPs in adults below 139/86 mm Hg might be considered normal, whereas values over 149/95 mm Hg might be considered pathologic. Verification of these conclusions is needed, however, in larger series and with the use of additional measures of preclinical hypertensive disease.