Can left ventricular pathological hypertrophy in hypertensives be distinguished from physiological hypertrophy in athletes?

Background and objective: Patients with hypertensive heart disease and left ventricular hypertrophy demonstrate impaired left ventricular diastolic fi lling. Aim of this study was to find out if physiological left ventricular hypertrophy induced by endurance training causes abnormal left ventricular systolic and diastolic filling. Methods: We examined 42 athletes with left ventricular hypertrophy due to e ndurance training (aged 25 +/- 7 years), 31 patients with left Ventricular hypertrophy due to hypertensive heart disease (aged 28 +/- 6 years) and 20 untrained, healthy subjects (controls, aged 26 +/- 8 years) by conventional echocardiography and calculated left ventricular muscle mass and fractiona l shortening. In addition the following Doppler-echocardiographic parameter s were measured: maximal early and late velocity of diastolic filling, rati o of maximal early and late velocity of diastolic filling, acceleration and deceleration time and isovolumetric relaxation time. Results: All three study groups showed normal fractional shortening. Conven tional echocardiography revealed a higher left ventricular muscle mass in t he two study groups as compared to the controls (controls: 119 +/- 12 g, at hletes: 225 +/- 18 g*; hypertensive patients: 216 +/- 16 g*; * p < 0.01 ver sus controls). In the athletes with physiological left ventricular hypertro phy a normal left ventricular diastolic filling pattern was documented (V-E : 0,64 +/- 0,1 m/ s; V-A: 0,51 +/- 0,2 m/s). In hypertensive heart disease a diastolic dysfunction in terms of a delayed relaxation pattern with a dec rease of maximal early velocity of diastolic filling (V-E: 0,45 +/- 0,09 m/ s) and a compensatory increase of the maximal late velocity of diastolic fi lling (V-A: 0,54 +/- 0,1 m/s) was demonstrated. Conclusion: In pathological left Ventricular hypertrophy due to hypertensiv e heart disease a pathological diastolic filling pattern was documented. In athletes with physiological left ventricular hypertrophy a normal left ven tricular diastolic filling pattern was revealed. Thus Doppler-echocardiogra phic parameters of left ventricular diastolic function can be of diagnostic importance for discriminating between pathological and physiological left ventricular hypertrophy.