Left ventricular hypertrophy and geometry in a population sample of elderly males

BACKGROUND: Recent studies have shown that left ventricular geometric adaptation to hypertension is complex. The spectrum of geometric adaptations in a general population and its relationship to systolic and diastolic function has, however, not been investigated. OBJECTIVES AND METHODS: This echocardiographic and Doppler study investigated the relationships between left ventricular geometric shape (normal, concentric remodelling, concentric hypertrophy and eccentric hypertrophy) and left ventricular systolic and diastolic function in a population sample of 584 males aged 70 in Uppsala, Sweden. The influences of hypertension, coronary heart disease and diabetes mellitus were also evaluated. RESULTS: Sixteen percent of the healthy population (n = 167) demonstrated the presence of left ventricular hypertrophy (mainly eccentric). Subjects with hypertension (n = 115) showed an increased left ventricular mass (eccentric left ventricular hypertrophy 31%, concentric left ventricular hypertrophy 15%), when compared with healthy subjects (P < 0.001). Subjects with coronary heart disease (n = 32) without hypertension also showed an increased left ventricular mass (most often eccentric) (P < 0.05). Using Doppler determinations of cardiac index, no differences were found in cardiac index between the geometric groups. Raised total peripheral resistance, increased blood pressure and enlarged left atrium were found in both concentric and eccentric left ventricular hypertrophy (P < 0.01-0.05). Disturbed diastolic function was seen with a prolongation of the isovolumic relaxation time in eccentric (P < 0.01) and increased atrial-dependent left ventricular filling in concentric left ventricular hypertrophy (P < 0.05). CONCLUSION: Alterations in left ventricular geometry were common in this population-based study of elderly males, both in healthy subjects and in subjects with hypertension or coronary heart disease. Raised total peripheral resistance and left ventricular diastolic dysfunction were common findings in both concentric and eccentric left ventricular hypertrophy.