Prognostic Significance of Serial Changes in Left Ventricular Mass in Essential Hypertension

Verdecchia, Paolo; Schillaci, Giuseppe; Borgioni, Claudia; Ciucci, Antonella; Gattobigio, Roberto; Zampi, Ivano; Reboldi, Gianpaolo; Porcellati, Carlo

doi:10.1161/01.cir.97.1.48

Cited by 579 publications

(363 citation statements)

References 40 publications

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“…Various observational studies suggest that LVH reversal is beneficial beyond BP reduction and treatment by demonstrating that CV events occur in higher proportion of individuals in whom LVH progresses than regresses. 19,38 These findings suggest that the level of LV mass during antihypertensive treatment reflects independent information regarding disease progression or its control. Confirmation of this hypothesis comes from two landmark trials; the HOPE and LIFE trials.…”

Section: Ecg Lvh Regression and Prognosismentioning

confidence: 89%

The prognostic value of the ECG in hypertension: where are we now?

Ang

Lang

2008

J Hum Hypertens

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In hypertension, the presence of left ventricular hypertrophy (LVH) is associated with increased risk of both cardiovascular morbidity and mortality. To date, the electrocardiogram (ECG) remains the cornerstone of LVH diagnosis in clinical practice because it is universally available, technically easy to perform and highly specific. In the most recent European Society of Hypertension/European Society of Cardiology guidelines for the treatment of arterial hypertension, the Sokolow-Lyon voltage criterion was recommended as part of all routine assessment of subjects with hypertension. However, the use of the ECG in the diagnosis of LVH is somewhat limited by its poor sensitivity. In this review article, we discuss the individual strength and weaknesses of the commonly used ECG criteria in diagnosing LVH. In addition, we present the latest data on the prognostic significance of ECG LVH and the survival differences conferred in different genders. In view of the recent Losartan Intervention for Endpoint Reduction in Hypertension trial, the prognostic benefit of LVH regression will also be addressed. Finally, with the wider availability of echocardiography, the role of combining both modalities to improve risk stratification in hypertension is reviewed.

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Section: Ecg Lvh Regression and Prognosismentioning

confidence: 89%

The prognostic value of the ECG in hypertension: where are we now?

Ang

Lang

2008

J Hum Hypertens

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“…13,14 Reduction in LV mass in turn reduces the repolarization time and its dispersion, [15][16][17] the incidence and severity of ventricular arrhythmias 2 and the risk for cardiovascular events. 18,19 We have recently shown that regression of LV mass induced by the angiotensin II type 1 receptor blocker (ARB) irbesartan rather than by the b 1 -selective adrenoceptor blocker atenolol is accompanied by improved repolarization. 16 There are, however, unsettled questions as to the effects of reverse remodelling by antihypertensive therapy.…”

Section: Introductionmentioning

confidence: 99%

Cardiac repolarization and its relation to ventricular geometry and rate in reverse remodelling during antihypertensive therapy with irbesartan or atenolol: results from the SILVHIA study

et al. 2007

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Hypertensive left ventricular (LV) hypertrophy is associated with a substantial risk for malignant arrhythmias and sudden death. According to recent results, antihypertensive therapy with the angiotensin II type 1 receptor blocker irbesartan reverses both structural and electrical remodelling. However, the relation between the LV geometric pattern (concentric vs eccentric) and electrical reverse remodelling has not been characterized, neither has the relation between repolarization and rate (QT/RR and JT/RR relation), which presumably reflects the propensity for bradycardia-dependent ventricular arrhythmia. In this study, repeat echocardiographic and electrocardiographic measurements were performed in hypertensive patients with LV hypertrophy, randomized to double-blind therapy with irbesartan (n ¼ 44) or the b 1 -adrenoceptor blocker atenolol (n ¼ 48) for 48 weeks; 53 patients had concentric and 39 eccentric LV hypertrophy. In addition, 37 matched hypertensive subjects without LV hypertrophy and no current therapy served as controls. Irbesartan induced structural and electrophysiological reverse remodelling, independent of LV geometry. In contrast, atenolol had similar beneficial effect only in patients with concentric LV hypertrophy, while the response in those with eccentric hypertrophy was unfavourable with both prolonged repolarization time and an increased QT/RR slope (suggesting reverse-use dependence). In conclusion, there is a significant geometry-related difference in the reverse remodelling processes induced by irbesartan and atenolol. Echocardiographic characterization of the geometry in hypertension-induced LV hypertrophy might become an important step in the selection of optimal antihypertensive therapy.

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“…The registry was approved by the local ethics committee of the Italian National Health Service and all patients provided their informed consent to participate. Details of the study have been published elsewhere 5, 9, 15. Entry criteria included an office systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg on at least 3 visits and absence of secondary causes of hypertension, previous cardiovascular disease, or life‐threatening conditions.…”

Section: Methodsmentioning

confidence: 99%

“…Only frames with optimal visualization of interfaces and showing simultaneous visualization of septum, LV internal diameter, and posterior wall were used for reading. Details about reading procedures and reproducibility in our laboratory have been previously reported 5, 9, 18. LVM was calculated by using a necropsy validated formula19 and corrected by height in meters at the power of 2.7 20.…”

Section: Methodsmentioning

confidence: 99%

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Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

Verdecchia¹,

Angeli

Bartolini³

et al. 2017

JAHA

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BackgroundThe different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear.Methods and ResultsWe studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24‐hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow‐up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient‐years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log‐rank test: P<0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24‐hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (P=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model.ConclusionsIn initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.

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Prognostic Significance of Serial Changes in Left Ventricular Mass in Essential Hypertension

Cited by 579 publications

References 40 publications

The prognostic value of the ECG in hypertension: where are we now?

The prognostic value of the ECG in hypertension: where are we now?

Cardiac repolarization and its relation to ventricular geometry and rate in reverse remodelling during antihypertensive therapy with irbesartan or atenolol: results from the SILVHIA study

Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

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