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European Heart Journal Advance Access published online on November 30, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi019
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

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

Giovanni de Simone 1*, Dalane W. Kitzman 2, Marcello Chinali 3, Albert Oberman 4, Paul N. Hopkins 5, D. C. Rao 6, Donna K. Arnett 7, and Richard B. Devereux 8

1 Weill Medical College of Cornell University, New York, NY, USA; Department of Clinical and Experimental Medicine, Federico II University Hospital, v. S. Pansini, 5 - 80131 Naples, Italy
2 Wake Forrest University School of Medicine, Winston-Salem, NC, USA
3 Weill Medical College of Cornell University, New York, NY, USA; Federico II University, Naples, Italy
4 University of Alabama at Birmingham, Birmingham, AL, USA
5 University of Utah School of Medicine, Salt Lake City, UT, USA
6 Washington University School of Medicine, St Louis, MO, USA
7 University of Minnesota, Minneapolis, MN, USA
8 Weill Medical College of Cornell University, New York, NY, USA

* To whom correspondence should be addressed.
Giovanni de Simone, E-mail: simogi{at}unina.it


  Abstract

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.

Keywords: Cardiac function; Hypertrophy; Arterial hypertension; Diastolic function; Cardiovascular risk.
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