Author + information
- Received June 13, 1994
- Revision received September 22, 1994
- Accepted September 28, 1994
- Published online March 15, 1995.
- Paolo Verdecchia, MDa,*,
- Giuseppe Schillaci, MD*,
- Claudia Borgioni, MDa,
- Antonella Ciucci, MDa,
- Massimo Battistelli, MDa,
- Carlo Bartoccini, MDa,
- Antonella Santucci, MD†,
- Carla Santucci, PhD†,
- Gianpaolo Reboldi, MD, MSc‡ and
- Carlo Porcellati, MDa
- ↵*Address for correspondence: Dr. Paolo Verdecchia. Ospedale Generale Regionale Raffaello Silvestrini, Unità Organica di Malattie Cardiovascolari e Medicina Interna, Località San Sisto, 06100 Perugia PG, Italy.
Objectives. We examined the prognostic significance of concentric remodeling of the left ventricle in patients with essential hypertension and normal left ventricular mass on echocardiography.
Background. An echocardiographic pattern of concentric remodeling of the left ventricle has been associated with clinical features of increased cardiovascular risk, but the independent prognostic value of this finding in hypertensive patients with normal left ventricular mass has not been established.
Methods. Six hundred ninety-four patients with essential hypertension and normal left ventricular mass (<125 g/m2) on echocardiography were prospectively followed up for ≤7.7 years (mean 2.71). Baseline echocardiography and 24-h noninvasive ambulatory blood pressure monitoring were performed in all patients at the time of initial diagnostic evaluation. Concentric remodeling was defined by the thickness of the septum or posterior wall divided by the left ventricular radius at end-diastole ≥0.45.
Results. Prevalence of concentric remodeling was 39.2%. During follow-up there were 29 cardiovascular morbid events. Cardiovascular morbidity, expressed as the combined number of fatal and nonfatal events per 100 patient-years, was 1.53 in the overall study group, 1.12 in the subgroup with normal left ventricular geometry and 2.39 in that with concentric remodeling. After assessment of the independent association with several covariates (age, gender, diabetes, left ventricular mass index, mean clinic blood pressure and mean 24-h ambulatory blood pressure) in Cox proportional hazard models, the risk of cardiovascular morbid events was higher in the group with concentric remodeling than in that with normal geometry (relative risk 2.56, 95% confidence interval 1.20 to 5.45, p < 0.01).
Conclusions. Concentric remodeling of the left ventricle, defined by the thickness of the septum or posterior wall divided by the left ventricular radius at end-diastole ≥0.45, is an important and independent predictor of increased cardiovascular risk in hypertensive patients with normal left ventricular mass on echocardiography.
This study was supported in part by funds provided by the Associazione Umbra Cuore e Ipertensione, Perugia, Italy. The staff of the Medical Department of Ciba-Geigy, Origgio, Italy provided technical support.
- Received June 13, 1994.
- Revision received September 22, 1994.
- Accepted September 28, 1994.
- American College of Cardiology