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

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Dario Turturiello¹  Fabio Angeli¹  Stefania Martone²  Elisa Ramundo²  Marta Garofoli²  Paolo Verdecchia²  Giovanni Mazzotta²  Francesca Valecchi²  Claudia Bartolini²  Cristina Poltronieri²  Maria Gabriella Pinzagli²  Adolfo Aita²  Gianpaolo Reboldi³ 

[1] Cardiology and Cardiovascular Pathophysiology, Hospital and University of Perugia, Italy;Department of Medicine, Hospital of Assisi, Italy;Department of Medicine, University of Perugia, Italy;

关键词: ambulatory blood pressure monitoring;    echocardiography;    geometry;    left ventricular hypertrophy;    left ventricular mass;   

DOI  :  10.1161/JAHA.117.005948

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown