Hypertension and left ventricular hypertrophy

Abstract

Left ventricular hypertrophy (LVH) is an abnormal increase in left ventricular mass. which is a marker for and contributes to coronary events, stroke, heart failure, peripheral arterial disease, and cardiovascular mortality in patients with hypertension (1-12). LVH is commonly measured by electrocardiography, echocardiography, and magnetic resonance imaging Concentric LVH is an increased left ventricular mass index with a relative wall thickness ≥0.45 (1). Eccentric LVH is an increased left ventricular mass index with a relative wall thickness <0.45 (1). Concentric left ventricular remodeling is a relative wall thickness ≥0.45 with a normal left ventricular mass index. Factors influencing left ventricular geometry in persons with hypertension include: (I) the severity, duration, and rapidity of onset of the increased pressure load; (II) the volume load; (III) age, race/ethnicity, and sex; (IV) comorbidities such as coronary artery disease, diabetes mellitus, obesity, and valvular heart disease; (V) the neurohormonal milieu; (VI) alterations of the extracellular matrix; and (VII) genetic factors (13). Blacks with hypertension are more likely than whites with hypertension to develop concentric LVH (13). Women with hypertension are more likely than men with hypertension to develop concentric LVH (13). Increasing age in patients with hypertension is associated with concentric LVH (13). Diabetes mellitus in patients with hypertension is associated with concentric LVH, whereas obesity, which is a volume overload state, and coronary artery disease in patients with hypertension are more likely to be associated with eccentric LVH (13).The electrocardiogram is less sensitive than the echocardiogram or magnetic resonance imaging in diagnosing LVH. In a blinded prospective study of 476 patients aged 62 years and older, echocardiographic LVH was 67% to 71% present in 167 patients (35%) (14). The sensitivity of 5 different electrocardiographic criteria in diagnosing LVH varied from 12% to 29%, the specificity from 93% to 96%, the positive predictive value from 62% to 71%, and the negative predictive value from 67% to 71% (14). The Cornell criteria (15) had the highest sensitivity (29%) in predicting LVH, a specificity of 93%, a positive predictive value of 69%, and a negative predictive value of 71% (14).In a prospective study of 84 blacks and 326 whites older than 62 years with hypertension, echocardiographic LVH was present in 71% of blacks and in 56% of whites (1). Electrocardiographic LVH was present in 20% of blacks and in 15% of whites (1). Concentric LVH was present in 60% of blacks and in 40% of whites (1). Eccentric LVH was present in 12% of blacks and in 17% of w h i t e s ( 1 ) . A t 3 7 -m o n t h f o l l o w -u p o f b l a c k s , echocardiographic LVH increased the incidence of new coronary events 3.33 times, new stroke 2.76 times, and new congestive heart failure 3.69 times (1). At 43-month follow-up of whites, echocardiographic LVH increased the incidence of new coronary events 2.72 times, new stroke 2.76 time...

Hypertension, aortic stenosis, and aortic regurgitation

“…The prevalence of hypertension (1) and of valvular aortic stenosis (2) increase with age, and both hypertension (3,4) and valvular aortic stenosis (5) cause left ventricular hypertrophy. Both hypertension (1,3) and valvular aortic stenosis (2,6) are also associated with an increased incidence of cardiovascular events and mortality.…”

Regression from pathological hypertrophy is sexually dimorphic and stimulus-specific

“…Pathological cardiac hypertrophy can be reversed with pharmacological treatment, weight loss or surgery in some patients; however, not all patients are able to regress (1, 4, 6–8) . Because cardiac hypertrophy itself is a risk factor for mortality, it is crucial that we have a better understanding of mechanisms that lead to the state of irreversibility and mechanisms that promote regression from pathological cardiac hypertrophy.…”

“…Cardiac hypertrophy is a major risk factor for mortality and can be caused by high blood pressure, diabetes, mutations in sarcomeric proteins, and aortic valve stenosis (1–4) . In mammals, this hypertrophy is the result of increased cardiomyocyte size, leading to thickening of the left ventricular (LV) walls and a decrease in the LV chamber.…”

He Role of Fatty Acid Contents of Erythrocytes Membranes in Cardiohemodynamics Disorder in Gout Patients With Insulin Resistance Syndrome

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