PROGNOSTIC VALUE OF LEFT-VENTRICULAR MASS AND GEOMETRY IN SYSTEMIC HYPERTENSION WITH LEFT-VENTRICULAR HYPERTROPHY

To determine the independent prognostic significance of left ventricul ar (LV) mass and geometry (concentric vs eccentric pattern) in hyperte nsive subjects with LV hypertrophy at echocardiography, 274 subjects w ere followed for up to 8.7 years (mean 3.2), All patients had systemic hypertension and LV mass greater than or equal to 125 g/body surface area (BSA) and underwent ambulatory blood pressure (BP) monitoring and echocardiography before treatment. Eccentric and concentric hypertrop hy were defined by the ratio between LV posterior wall thickness and L V radius at telediastole <0.45 and greater than or equal to 0.45, resp ectively. Age, sex ratio, body mass index, office BP and serum glucose , cholesterol, and triglycerides did not differ between the groups wit h eccentric (n=145) and concentric (n=129) hypertrophy. Average 24-hou r, daytime, and nighttime systolic ambulatory BPs were higher in conce ntric than in eccentric hypertrophy (all p<0.01). LV mass was slightly greater in concentric than in eccentric hypertrophy (157 vs 149 g/BSA , p<0.05). Endocardial and midwall shortening fraction were lower in c oncentric than in eccentric hypertrophy (96.5% vs 106.0% of predicted and 71.4% vs 89.7% of predicted, respectively; both p<0.01). The rate of major cardiovascular morbid events was 2.20 and 3.34 per 100 patien t-years in eccentric and concentric hypertrophy, respectively (log ran k test, p=NS). Age >60 and LV mass above median (145 g/BSA) were signi ficant adverse prognostic predictors, while LV geometry (eccentric vs concentric hypertrophy) and ambulatory BP were not. The event rates pe r 100 patient-years were 1.38 and 3.98, respectively, in the patients with LV mass below and above median (age-adjusted relative risk 2.70; 95% confidence interval [CI] 1.03 to 6.63; p=0.015). In hypertensive s ubjects with established LV hypertrophy, LV mass, but not its geometri c pattern, provides important prognostic information independent of co nventional risk markers including office and ambulatory BP.