Cardiovascular risk in relation to a new classification of hypertensive left ventricular geometric abnormalities
- 1 April 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Hypertension
- Vol. 33 (4), 745-754
- https://doi.org/10.1097/hjh.0000000000000477
Abstract
Objectives: In 2010, the Dallas Heart Study proposed an upgrade of the left ventricular geometric classification proposed in 1991, by using left ventricular mass combined with end diastolic volumes, and introducing the new categories of dilated left ventricular hypertrophy (LVH). We adopted the new method to test the prognostic impact of the left ventricular geometric patterns from the new classification. Methods: We evaluated baseline anthropometric, laboratory and echocardiographic parameters of 8848 hypertensive patients from the Campania Salute Network (53 ± 12 years, 56% male), free of prevalent cardiovascular disease, valve disease and with ejection fraction ≥50%. Cut points for left ventricular mass index, relative wall thickness and left ventricular end-diastolic dimension (cm/m) were derived from our historical normal reference population. Composite cardiovascular end-points were cardiac death, fatal and nonfatal myocardial infarction and stroke. Results: Independent of confounders, eccentric dilated LVH, concentric nondilated LVH and concentric dilated LVH were associated with higher cardiovascular risk (hazard ratios between 2 and 9, all P < 0.01), mostly depending on the magnitude of LVM index. A volume load was present especially in dilated forms of LVH, the extent of which was important in the determination of harmful types of left ventricular geometry. Conclusion: Consideration of left ventricular dilatation in the evaluation of risk related to hypertensive left ventricular geometry reveals the importance of the extent of the volume load coexisting with the typical hypertensive pressure overload. At a given normal ejection fraction, the balance between the two hemodynamic components influences the shape of left ventricular geometric adaptation, the amount of left ventricular mass and the impact on prognosis.This publication has 31 references indexed in Scilit:
- Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patientsJournal of Hypertension, 2013
- Are Observational Studies More Informative Than Randomized Controlled Trials in Hypertension?Hypertension, 2013
- Hypertensive target organ damage predicts incident diabetes mellitusEuropean Heart Journal, 2013
- Initial left-ventricular mass predicts probability of uncontrolled blood pressure in arterial hypertensionJournal of Hypertension, 2011
- Does Information on Systolic and Diastolic Function Improve Prediction of a Cardiovascular Event by Left Ventricular Hypertrophy in Arterial Hypertension?Hypertension, 2010
- Left Ventricular MassHypertension, 2010
- A 4-Tiered Classification of Left Ventricular Hypertrophy Based on Left Ventricular GeometryCirculation: Cardiovascular Imaging, 2010
- Insufficient Control of Blood Pressure and Incident DiabetesDiabetes Care, 2009
- Estimate of white-coat effect and arterial stiffnessJournal of Hypertension, 2007
- Prognosis of Inappropriate Left Ventricular Mass in HypertensionHypertension, 2002