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European Heart Journal Advance Access originally published online on November 30, 2004
European Heart Journal 2005 26(10):1039-1045; doi:10.1093/eurheartj/ehi019
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© The European Society of Cardiology 2004. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Left ventricular concentric geometry is associated with impaired relaxation in hypertension: the HyperGEN study

Giovanni de Simone1,2,*, Dalane W. Kitzman3, Marcello Chinali1,2, Albert Oberman4, Paul N. Hopkins5, Dabeeru C. Rao6, Donna K. Arnett7 and Richard B. Devereux1

1Weill Medical College of Cornell University, New York, NY, USA
2Federico II University, Naples, Italy
3Wake Forrest University School of Medicine, Winston-Salem, NC, USA
4University of Alabama at Birmingham, Birmingham, AL, USA
5University of Utah School of Medicine, Salt Lake City, UT, USA
6Washington University School of Medicine, St Louis, MO, USA
7University of Minnesota, Minneapolis, MN, USA

Received 10 May 2004; revised 25 August 2004; accepted 16 September 2004; online publish-ahead-of-print 30 November 2004.

* Corresponding author. Department of Clinical and Experimental Medicine, Federico II University Hospital, v. S. Pansini, 5 – 80131 Naples, Italy. Tel: +39 081 746 2013; fax: +39 081 546 6154. E-mail address: simogi{at}unina.it

Aims We tested the hypothesis that abnormal left ventricular (LV) relaxation is associated with concentric LV geometry.

Methods and results Doppler LV filling properties were studied in 1384 hypertensive participants without cardiovascular disease, from the HyperGEN population (731 women, 784 obese, 236 diabetic) and compared in four LV geometry groups; normal, concentric remodelling (3.5%), eccentric (23%), and concentric LV hypertrophy (4%), based on echocardiographic LV mass index (in g/m2.7). Abnormal LV relaxation was identified by European Society of Cardiology criteria in 275 subjects (20%). After accounting for significant confounders, E/A ratio and isovolumic relaxation time were not related to the presence of LV hypertrophy, but indicated abnormal relaxation when LV geometry was concentric (both P<0.0001). Deceleration time of E velocity was prolonged with LV hypertrophy (P<0.03), but the behaviour in relation to concentric LV geometry differed in the presence (prolonged) or absence (reduced) of LV hypertrophy (P=0.05), a difference independently related to the magnitude of both transmitral gradients and stroke volume (all P<0.05). Logistic regression showed that, compared with normal LV geometry, the odds of abnormal LV relaxation was 2.3-fold greater when LV geometry was concentric and that LV hypertrophy conferred a borderline higher risk than normal LV mass.

Conclusions In hypertensive individuals without prevalent cardiovascular disease from a multi-ethnic population-based sample, delayed LV relaxation is independently associated with concentric LV geometry.

Key Words: Cardiac function • Hypertrophy • Arterial hypertension • Diastolic function • Cardiovascular risk


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