Author + information
- Iman Suhartono1,
- Johan Senihardja1,
- Rizki Francis Pandelaki1,
- Benny Mulyanto Setiadi1,
- Bambang Budiono2,
- Janry Anton Pangemanan1 and
- Agnes Lucia Panda1
Recently, hypertension is one of the most cardiovascular diseases in worldwide. It has played role in contributing to coronary artery disease event. The prevalence of hypertension is about 20% of the adult population. Left ventricle hypertrophy (LVH) is the response from prolonged hypertension. LVH is divided into, concentric and eccentric type. The former paradigm stated that eccentric type occurred when concentric type progressing to more severe form. According to this statement, the eccentric type of hypertrophy should have had more severe coronary artery disease. The new paradigm stated that concentric type had more event and the eccentric type could occur either from concentric or normal. Therefore, our aim is to compare the severity of coronary artery disease between these LVH groups.
This was observational cross-sectional study, The inclusion criteria were the patient who had a history of hypertension who underwent coronary angiography, and the exclusion criteria were the patient who already had a history of PCI or CABG, valve abnormalities, HCM, left ventricle deformities, or the patient with an acute myocardial infraction. LVH was measured by echocardiography using Left Ventricle Mass Index (LVMI) and Relative Wall Thickness (RWT) parameter, and the divided into concentric type and eccentric type. The severity of coronary artery was calculated using SYNTAX Score. Then, the SYNTAX Score between these groups was compared.
Totally, there were 55 patients involved in this study, 40 males and 15 males, with mean age 61.64 years. The subject in the concentric group had older age compared with the eccentric group, 64.96 + 8.34 and 58.66 + 7.58 years old, with p-value 0.008, respectively. However, between the concentric group and eccentric group, there were not significant difference in systolic blood pressure and LVMI, 130 + 8 and 128.1 + 16.82 mmHg with p-value 0.193, 150.27 + 30.68 and 142.55 + 38.73 g/m2, p-value 0.203, respectively. In this study, distribution data SYNTAX Score varied greatly from total point 1 to 47 with mean 20.15 + 12.74. The data distribution was normal. The minimum and maximum SYNTAX Score for concentric type LVH were 8 and 47, and for eccentric type were 1 and 30. The analysis showed the patients in concentric group had greater SYNTAX Score compared to eccentric group (27.79 + 12.05 vs 13.29 + 8.79 with p-value<0.01).
Nowadays, the incidence of coronary artery disease is more often in concentric type rather than eccentric type LVH. Our study has demonstrated that patient fall into concentric type LVH category had greater SYNTAX Score compared to eccentric type category. Therefore, the concentric groups will have greater coronary artery disease event and worse outcome. This new concept of the type of LVH associated with coronary artery disease needs further investigation, in order to increase our concern and prevent increasing the incidence of coronary artery disease.