Impact of Different Partition Values on Prevalences of Left Ventricular Hypertrophy and Concentric Geometry in a Large Hypertensive Population

Abstract

Abstract-Left ventricular (LV) hypertrophy and concentric remodeling have been defined by using a variety of indexation methods and partition values (PVs) for LV mass and relative wall thickness (RWT). The effects of these methods on the distribution of LV geometric patterns in hypertensive subjects remain unclear. RWT was calculated by either 2ϫend-diastolic posterior wall thickness (PWT)/enddiastolic LV internal dimension (LVID) or end-diastolic interventricular septum dimensionϩend-diastolic PWT/enddiastolic LVID. LV hypertrophy or remodeling was present in 63% to 86% of subjects, and LV hypertrophy was present in 42% to 77%. By any index, eccentric hypertrophy was the common LV geometric pattern. Use of interventricular septum dimensionϩPWT/LVID to calculate RWT slightly increased the prevalence of normal geometry and eccentric hypertrophy compared with the use of 2ϫPWT/LVID. Subjects with LV hypertrophy identified by only LV mass/height 2.7 PV 49.2/46.7 were more obese, whereas those identified by only LV mass/body surface area PV 116/104 were taller and thinner than those in the 2 concordant groups with or without LV hypertrophy by both criteria. By either criterion, there were no significant differences between different LV geometric patterns in clinical cardiovascular disease. Hypertensive patients with LV hypertrophy by ECG have a high prevalence of geometric abnormalities, especially eccentric hypertrophy, irrespective of method of indexation or PV. LV mass indexation by body surface area or height 2.7 identifies lean and obese subjects, respectively. We found no difference in prevalent cardiovascular disease in subjects identified by either criterion, suggesting a similar high risk. (Hypertension. 2000;35:6-12.) Key Words: echocardiography Ⅲ electrocardiography Ⅲ hypertrophy, left ventricular Ⅲ hypertension, essential L eft ventricular (LV) hypertrophy, as determined by echocardiography, has been shown to be a strong predictor of adverse prognosis independent of and, in most instances, stronger than conventional risk factors. 1-3 On the basis of distributions of indexed echocardiographic LV mass in normal populations, LV hypertrophy has been identified by calculation of LV mass that has been indexed for body surface area (BSA) 1,4 -6 or for BSA 1.5 , 7 height, height 2.0 , 8 height 2.13 , 9 height 2.7 , 7,9,10 or height 3.0 . 11 The combination of LV mass index (LVMI) and relative wall thickness (RWT) has been used to identify 3 different abnormal LV geometric patterns. 2,12 RWT has been calculated either as the ratio of 2ϫposterior wall thickness/LV internal diameter 13 or as the ratio of (interventricular septalϩposterior wall thickness)/LV internal diameter. 14 The relation between LVMI and RWT seems important in view of the fact that several studies have shown that stratification by different geometric patterns gives valuable information concerning morbidity and mortality. In these studies, subjects with concentric hypertrophy (ie, increased RWT and LVMI) had the highest incidence of cardiovascula...

Microalbuminuria is associated with unfavourable cardiac geometric adaptations in essential hypertensive subjects

“…LV hypertrophy was considered present if LVMIϾ104 g/m 2 in women and Ͼ116 g/m 2 in men. 15,16 Normal geometry was considered when LV mass did not extend the above gender specific values. Concentric LV hypertrophy was considered present if relative wall thickness was Ͼ0.43 and eccentric LV hypertrophy when relative wall thickness was р0.43.…”

“…Concentric LV hypertrophy was considered present if relative wall thickness was Ͼ0.43 and eccentric LV hypertrophy when relative wall thickness was р0.43. 15 Concentric remodelling was considered present in patients with normal LVMI and relative wall thickness р0.43.…”

Influence of different echocardiographic criteria for detection of left ventricular hypertrophy on cardiovascular risk stratification in recently diagnosed essential hypertensives

“…The prevalence of LVH, according to eight different partition values, ranged from 42% to 77%. 18 The wide variations in LVH prevalence observed in these and other studies 17,30 stress the need of definite operative criteria in order to allow a more standardised stratification of cardiovascular risk in hypertensives.…”

“…[11][12][13] Furthermore a number of criteria, based on LVM (indexed for body surface mass, height or height 2.7 , gender specific and not) have been proposed and a considerable controversy exists regarding both optimal method for indexing LVM for body size and threshold values for defining LVH. [14][15][16][17][18] The aim of the present study was to evaluate the impact of detection of cardiac hypertrophy by different echocardiographic criteria in modifying the level of absolute cardiovascular risk as estimated by usual clinical and laboratory evaluation according to WHO/ISH guidelines in a group of untreated grade 1 and 2 essential hypertensive patients without evidence of target organ damage (TOD) as preliminarily assessed by routine investigations.…”

Sex-related difference in regression of left ventricular hypertrophy with antihypertensive treatment: the LIFE study

“…After a run-in period that documented eligible levels of clinic blood pressure during 1479 days of placebo treatment, subjects underwent baseline echocardiography. 15 Arterial blood pressure was also measured by an arm cuff sphygmomanometer at the end of the echocardiogram, after subjects had been resting supine in a dimly lit room for approximately 30 min. Patients with severe (3 þ or 4 þ ) aortic or mitral regurgitation were excluded from the present analysis.…”