Distribution of cardiac geometric patterns on echocardiography in essential hypertension. Impact of two criteria of stratification

Abstract

Rosa et al Cardiac geometry in essential hypertensionIn recent years, the use of echocardiography made possible a better characterization of the cardiac morphometric and functional changes in essential hypertension 1,2 . The prevalence of left ventricular hypertrophy, which is estimated in approximately 5% 2-4 according to electrocardiographic criteria, has ranged from around 20% to 40% in hypertensive populations and from 0 to 10% in normotensive populations assessed on echocardiography [5][6][7] . The use of more sophisticated tools may also detect more accurately the early cardiac structural changes that precede left ventricular hypertrophy.Recent studies [8][9][10] , which have assessed in a global way the spectrum of cardiac geometric changes on echocardiography in hypertensive patients, have established the concept of early cardiac remodeling. This concept along with prospective studies of morbidity and mortality [11][12][13][14][15][16] have shown a greater cardiac risk for hypertensive individuals with concentric remodeling and hypertrophy, as compared with patients with normal geometry on echocardiography. This has, therefore, created a greater need for stratifying hypertensive patients in earlier phases of cardiac structural changes. Until then, these patients, unlike those patients with left ventricular hypertrophy, were considered as a low cardiovascular risk group.The diagnosis of left ventricular hypertrophy has been based on pre-established criteria, whose limits for the cardiac mass index have been obtained in referred normotensive populations.Therefore, adequate stratification of hypertensive patients requires pre-established limits of cardiac mass index.Some studies, including that of Cornell University 17 and the Framingham Study 18 , have established limit values of ventricular mass index, which were calculated based on percentiles or standard deviations of the average of the cardiac mass index in populations of normotensive males and females. These limit values were, respectively, 134 and 110g/ m 2 at Cornell University study, and 131 and 100g/m 2 in the