Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy (the LIFE study)

Abnormal left ventricular (LV) filling may exist in early stages of hyperte nsion. Whether this finding is related to LV hypertrophy is currently contr oversial. This study was undertaken to assess relations between abnormal di astolic LV filling and LV geometry in a large series of hypertensive patien ts with electrocardiographic LV hypertrophy. M-mode, 12-dimensional, and pu lsed Doppler echocardiographic recordings of mitral inflow velocity and iso volumetric relaxation time (IVRT) were obtained in 750 patients with stage I to III hypertension and LV hypertrophy determined by electrocardiography (sex-adjusted Cornell voltage duration criteria or Sokolow-Lyon voltage cri teria) after 14 days of placebo treatment. The patients' mean age was 67 +/ - 7 years and 44% were women. One hundred forty patients (19%) had normal L V geometric pattern, 79 (11%) had concentric remodeling, 342 (45%) had ecce ntric LV hypertrophy, and 189 (25%) had concentric LV hypertrophy. A normal LV filling pattern was found in 116 patients (16%), abnormal relaxation in 519 (69%), "pseudonormal" filling was found in 83 (11%), and a restrictive filling pattern in 32 (4%). Prolonged IVRT was associated with LV hypertro phy (p <0.01) as well as elevated relative wall thickness (p <0.05). A stro nger difference (p <0.01) in IVRT was found between groups with and without LV hypertrophy. Multiple regression analysis revealed that increased LV ma ss correlated with prolonged IVRT, whereas LV mass and geometry were not as sociated with peak early LV filling velocity (E), peak atrial filling veloc ity (A) ratio or mitral valve E-peak deceleration time, although IVRT was f ound to be an independent correlate of E/A ratio and deceleration time. Thu s, abnormal IVRT was highly prevalent in all LV geometric subgroups among h ypertensive patients with electrocardiographic LV hypertrophy, even in thos e with normal LV geometry determined by echocardiography. We found that IVR T differed significantly among patient groups with different LV geometric p atterns, primarily because of the association of IVRT to LV mass. (C) 2000 by Excerpta Medico, Inc.