No abstract

Abnormal left ventricular (LV) geometry, including LV hypertrophy (LVH), is associated with increased risk of major cardiovascular (CV) events and all-cause mortality and may be an independent predictor of morbid CV events. Patients with LVH have increased risk of congestive heart failure, coronary heart disease, sudden cardiac death and stroke. We review the risk factors for LVH and its consequences, as well as the risk imposed by concentric remodeling (CR). We also examine evidence supporting the benefits of LVH regression, as well as evidence regarding the risk of CR progressing to LVH, as opposed to normalization of CR. We also briefly review the association of abnormal LV geometry with left atrial enlargement and the combined effects of these structural cardiac abnormalities.

Left ventricular hypertrophy (LVH) was one of the earliest studied echocardiographic characteristics of the left ventricle. As the myriad of measurable metrics has multiplied over recent years, this reliable and relevant variable can often be overlooked. In this paper, we discuss appropriate techniques for accurate analysis, underlying pathophysiology, and the contributions from various risk factors. The prognostic implications of LVH on stroke, serious arrhythmias, and sudden cardiac death are reviewed. Finally, we examine the effect of therapy to reduce LVH and the resultant clinical outcomes.

No abstract

Hypertension (HTN) is a global health problem and a leading risk factor for cardiovascular disease (CVD) morbidity and mortality. The hemodynamic overload from HTN causes left ventricular (LV) remodeling, which usually manifests as distinct alterations in LV geometry, such as concentric remodeling or concentric and eccentric LV hypertrophy (LVH). In addition to being a common target organ response to HTN, LV geometric abnormalities are well-known independent risk factors for CVD. Because of their prognostic implications and quantifiable nature, changes in LV geometric parameters have commonly been included as an outcome in anti-HTN drug trials. The purpose of this paper is to review the relationship between HTN and LV geometric changes with a focus on (1) diagnostic approach, (2) epidemiology, (3) pathophysiology, (4) prognostic effect and (5) LV response to anti-HTN therapy and its impact on CVD risk reduction.

No abstract

LAE was independently associated with an increased risk of all-cause mortality in our large cohort of 10,719 patients with normal LV filling pressure and preserved LVEF.

Left ventricular (LV) hypertrophy (LVH) is a known independent determinant of left atrial (LA) size; however, there is controversy regarding whether the LV geometric patterns are associated with LA enlargement (LAE), a major indicator of diastolic heart failure. The authors evaluated 47,865 patients with preserved ejection fraction to determine the relationship of LV geometry on LAE as determined by LA volume index (LAVi) !29 mL ⁄ m 2 . Abnormal LV geometry was identified in 48% and LAE was indentified in 43% with associated higher prevalence of abnormal LV geometry (59% vs 41%, P<.0001). Both LV mass index and relative wall thickness (RWT) were independent determinants of LAE (P<.0001). LAVi and prevalence of LAE differ significantly by LV geometric patterns (P<.0001). In multivariate analysis, abnormal LV geometry patterns, especially eccentric and concentric LVH, were independently associated with LAE. In conclusion, LAE assessed as increased LAVi is strongly associated not only with LV mass index but also with RWT. Furthermore, LAE was independently associated with abnormalities in LV geometry. Congest Heart Fail. 2012;18:4-8. Ó2011 Wiley Periodicals, Inc.Left ventricular (LV) hypertrophy (LVH) as well as distinct LV geometric patterns are independent predictors of cardiovascular (CV) morbidity and mortality.1-5 By altering LV diastolic effects, these adaptive changes in the LV facilitate the development of left atrial (LA) enlargement (LAE), 6,7 a clinically significant determinant of adverse CV outcomes, including diastolic heart failure.7-11 An independent association of LV mass (LVM) or LVH with LAE has been shown in several studies. [12][13][14][15] Similarly, LAE is a common echocardiographic finding in patients with different abnormal LV geometric patterns. However, controversies still exist regarding the relationship of LAE with individual LV geometry. Current data in this regard lack consensus and range from the association of LAE with only eccentric LVH (EH) 12 or concentric LVH (CH) 13 or both 14 to lack of association with LV geometry. 15The present study evaluated 47,865 patients with preserved LV ejection fraction (LVEF) to determine whether the various LV geometric patterns are associated with LAE as determined by LA volume adjusted for body surface area or LA volume index (LAVi). METHODS Patient SelectionWe obtained clinical and echocardiographic data from a clinical echocardiographic report database (cardiovascular information system) of 47,865 studies that were recorded at Ochsner Clinic Foundation (New Orleans, LA) between January 2004 and December 2006. The patients who were selected for the study had preserved LV systolic function (defined as LVEF !50%) and absence of moderate or severe valvular heart disease. Patients with missing clinical or echocardiographic information were also excluded from the study. This study was approved by the institutional review board of the Ochsner Clinic Foundation.Echocardiographic Methods M-mode and 2-dimensional images were obtained with commercially av...