Key Points
- To re-evaluate left ventricular performance across different structural patterns of hypertensive cardiac adaptation using echocardiographic and hemodynamic techniques.
- Assessed 39 patients with established, uncomplicated primary hypertension (diastolic pressure > 100 mmHg) and 18 age-matched healthy controls.
- Categorized hypertensive patients via echocardiography into normal-sized heart (group 1, n=10), concentric left ventricular hypertrophy (group 2, n=18), and hypertrophy with cavity enlargement (group 3, n=11).
- Evaluated cardiac performance using the relationship between end-diastolic diameter and stroke index, as well as the mean velocity of circumferential fibre shortening (VCF).
- Systolic and diastolic blood pressures increased progressively from group 1 to group 2 to group 3.
- Left ventricular function was maintained in group 1, increased in group 2 despite higher pressure loads, and reduced in group 3 relative to healthy controls.
- Mean VCF was normal in group 1, significantly increased in group 2, and reduced in group 3.
Structured PICO
How does left ventricular geometry affect left ventricular function in patients with uncomplicated primary hypertension compared to healthy controls?
PPopulation39 patients with established, uncomplicated primary hypertension (diastolic pressure > 100 mmHg) and 18 age-matched healthy subjects.
CComparator18 age-matched healthy subjects (control group)
OOutcomeLeft ventricular function (assessed from the relation between diastolic diameter and stroke index) and mean velocity of circumferential fibre shortening (VCF)surrogate
Contrary to previous conclusions based on ECG and chest x-ray, echocardiographic assessment suggests that concentric left ventricular hypertrophy in sustained hypertension is associated with improved left ventricular function.
Limitations
- Impossible to discern whether the different behaviour of VCF in group 2 and in group 3 reflected opposite changes in ventricular contractility, or in wall stress during ejection, or in both