Author + information
- Received November 15, 1990
- Revision received December 10, 1991
- Accepted January 8, 1992
- Published online June 1, 1992.
- Antonello Ganau, MDa,
- Richard B. Devereux, MD, FACCa,∗,
- Mary J. Roman, MD, FACCb,
- Giovanni de Simone, MDb,
- Thomas G. Pickering, MDb,
- Pier Sergio Saba, MDa,
- Paolo Vargiu, MDa,
- Isabella Simongini, MDa and
- John H. Laragh, MD, FACCb
- ↵∗Address for reprints: Richard B. Devereux, MD, Division of Cardiology, Box 222, The New York Hospital-Cornell Medical College. 525 East 68th Street, New York, New York 10021.
The spectrum of left ventricular geometric adaptation to hypertension was investigated in 165 patients with untreated essential hypertension and 125 age- and gender-matched normal adults studied by two-dimensional and M-mode echocardiography. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 52%, whereas 13% had increased relative wall thickness with normal ventricular mass (“concentric remodeling”), 27% had increased mass with normal relative wall thickness (eccentric hypertrophy) and only 8% had “typical” hypertensive concentric hypertrophy (increase in both variables).
Systemic hemodynamics paralleled ventricular geometry, with the highest peripheral resistance in the groups with concentric remodeling and hypertrophy, whereas cardiac index was supernormal in those with eccentric hypertrophy and low normal in patients with concentric remodeling. The left ventricular shortaxis/long-axis ratio was positively related to stroke volume (r = 0.45, p < 0.001), with cavity shape most elliptic in patients with concentric remodeling and most spheric in those with eccentric hypertrophy. Normality of left ventricular mass in concentric remodeling appeared to reflect offsetting by volume “underload” of the effects of pressure overload, whereas eccentric hypertrophy was associated with concomitant pressure and volume overload.
Thus, arterial hypertension is associated with a spectrum of cardiac geometric adaptation matched to systemic hemodynamics and ventricular load. Concentric left ventricular remodeling and eccentric hypertrophy are more common than the typical pattern of concentric hypertrophy in untreated hypertensive patients.
☆ This study was supported in part by Grants HL 18323 from the National Heart, Lung, and Blood Institute and CRC 5M01 RR00047 from the National Institutes of Health, Bethesda, Maryland and by grants from Minislero Pubblica Istruzione (1990) and Regione Aulonoma Sardegna, Italy. This work was presented in part at the 38th Annual Scientific Session of the American College of Cardiology, Anaheim, California, March 1989.
☆☆ We remember the late Professor Salvatore Campus and his passionate contribution to the syudy of the in hypertension.
- Received November 15, 1990.
- Revision received December 10, 1991.
- Accepted January 8, 1992.