LEFT-VENTRICULAR CONTRACTILE PERFORMANCE AND GEOMETRIC REMODELING IN NEVER TREATED ESSENTIAL-HYPERTENSION

Left ventricular contractile performance and geometric adaptation to h ypertension were investigated in 255 patients with untreated essential hypertension and 160 normotensive subjects by M-mode echocardiography . Because all << ejection-phase >> measurements are affected by change s in afterload, ventricular performance was estimated at the operating level of systolic wall stress by the afterload-corrected fractional s hortening. Mitral regurgitation was excluded in all patients by Dopple r echocardiography. Patients were categorized according to values of e nd-diastolic relative wall thickness and left ventricular mass index. Among hypertensive patients, ventricular mass and relative wall thickn ess were normal in 44 %, whereas 20 % had increase relative wall thick ness with normal ventricular mass ''concentric remodeling'', 22 % had concentric hypertrophy (increase both ventricular mass and relative wa ll thickness) and 14 % had increased ventricular mass with normal rela tive wall thickness (eccentric hypertrophy). Arterial pressure and bod y mass index were higher in patients with concentric hypertrophy. Left ventricular contractile performance paralleled ventricular geometry, with a decrease of,the afterload-corrected fractional shortening in th e group with concentric remodeling and hypertrophy, whereas systolic f unction was normal in the eccentric group despite higher level of syst olic wall stress. This study suggests a strong dependence of left vent ricular mass with chamber size and myocardial contractility. Thus arte rial pressure was not the sole determinant of left ventricular hypertr ophy in essential hypertension. The respective role of this factors re mains to be determined.