LEFT-VENTRICULAR HYPERTROPHY AND GEOMETRIC REMODELING IN HYPERTENSION - STIMULI, FUNCTIONAL CONSEQUENCES AND PROGNOSTIC IMPLICATIONS

Objective: To provide a coherent overview of the stimuli to development of abnormal left ventricular geometric patterns, their impact on cardiac function and their relationship to the prognosis of hypertension, studies performed by the authors and other investigators are reviewed. Results: Clinical and experimental studies have shown that an elevated left ventricular mass reflects the additive effects on the heart of higher arterial pressure over time, increased cardiac volume load related to obesity, sodium intake or other stimuli, reduced contractile efficiency of the myocardium and altered arterial hemodynamics related to vascular hypertrophy and atherosclerosis. The heart may adapt to hypertension by developing concentric or eccentric left ventricular hypertrophy, or the newly described pattern of concentric left ventricular remodeling, or by retaining normal left ventricular geometry. Each geometric pattern is associated with a distinct combination of pressure and volume stimuli, contractile efficiency (reduced in those with concentric left ventricular hypertrophy or remodeling) and prognosis (worst with concentric hypertrophy and best with normal left ventricular geometry). An appraisal of left ventricular mechanics by a physiologically appropriate midwall-shortening/end-systolic stress relationship can identify impaired contractility in an appreciable proportion of hypertensive patients. Numerous studies have shown that increased left ventricular mass and abnormal geometry have a strong predictive value for cardiovascular death, myocardial infarction and stroke. Conclusions: Increasing evidence has demonstrated the central importance of left ventricular mass and geometry in the pathophysiology and prognosis of hypertension. These measures of preclinical disease can aid clinical decision-making by separating patients into those with a high or a relatively low risk, and hence a need for pharmacological treatment or its intensification, as well as providing useful bioassays for a spectrum of clinical and experimental research.