Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study
Department of Medicine, Division of Cardiovascular Medicine
Aged; Aged, 80 and over; Antihypertensive Agents; Blood Pressure; Body Mass Index; Dilatation; Double-Blind Method; Echocardiography; Electrocardiography; Female; Heart Ventricles; Hemodynamics; Humans; Hypertension; Hypertrophy, Left Ventricular; Losartan; Male; Middle Aged; Prevalence; Prospective Studies; *Systole; Ventricular Function, Left
Cardiology | Cardiovascular Diseases
BACKGROUND: Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients.
METHODS AND RESULTS: Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area > /=116 g/m in men and > /=96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05).
CONCLUSION: The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.
DOI of Published Version
J Hypertens. 2013 Oct;31(10):2060-8. doi: 10.1097/HJH.0b013e328362bbd6. Link to article on publisher's site
Journal of hypertension
Bang CN, Gerdts E, Aurigemma GP, Boman K, Dahlof B, Roman MJ, Kober L, Wachtell K, Devereux RB. (2013). Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.1097/HJH.0b013e328362bbd6. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/743