Impaired systolic and diastolic function and ventricular arrhythmia are common in normotensive healthy elderly men with left ventricular hypertrophy

BACKGROUND: The present study was designed to assess the impact of left ventricular hypertrophy (LVH) independent of hypertension on the presence of silent myocardial ischemia and arrhythmia, as well as on systolic and diastolic function in otherwise healthy elderly men. METHODS AND RESULTS: Twenty apparently healthy normotensive subjects with LVH were compared with 18 hypertensive subjects with LVH and with 20 healthy subjects without LVH (controls)--all recruited from a health screening programme of 70-year-old men. All participants were free from known coronary heart disease and were evaluated by means of echocardiography with Doppler, a symptom-limited exercise test and 24 h ambulatory ECG monitoring. The healthy normotensive subjects with LVH showed impaired systolic function (ejection fraction 66 +/- 8 (SD)% versus 72 +/- 8% in controls, P < 0.03) and impaired diastolic function (E/A ratio 0.86 +/- 0.20 versus 1.12 +/- 0.30, P < 0.01) as well as an increased number of premature ventricular complexes in the exercise test and during the 24 h ECG monitoring (P < 0.05), when compared with the healthy group without LVH. The hypertensive subjects with LVH showed impaired diastolic function (P < 0.05) and a more pronounced ST depression in the exercise test (P < 0.05), when compared with the healthy group without LVH. In both of the LVH groups, more than 20% of the subjects evidenced ST-segment depression > or = 1 mm in the exercise test, compared with 5% of the healthy group without LVH. CONCLUSIONS: In elderly men free from hypertension or other known disease, LVH at echocardiography was associated with impaired systolic and diastolic function as well as with ventricular arrhythmia. Thus, even in the absence of hypertension, LVH may be a harmful characteristic in the elderly.