Left ventricular function and hemodynamic features of inappropriate left ventricular hypertrophy in patients with systemic hypertension: The LIFE Study

Background Predicted left ventricular (LV) mass for sex, height(2.7), and h emodynamic load can be used as an intrapatient reference for the observed L V mass. The ratio of observed/predicted LV moss may allow more physiologica lly correct comparisons of LV geometry, systolic and diastolic functions, a nd hemodynamics among hypertensive patients. Methods We studied 659 participants in the LIFE (Losartan intervention for Endpoint Reduction in Hypertension) study with both electrocardiographic an d echocardiographic LV hypertrophy (68% of the echocardiographic cohort) wi thout previous myocardial infarction. LV mass was predicted by an equation including sex, stroke work, and height(2.7). Observed/predicted LV mass >12 8% defined inappropriate LV hypertrophy (iLVH). Relative wall thickness gre ater than or equal to0.43 defined concentric LV geometry. Systolic myocardi al dysfunction was assessed by midwall mechanics and abnormal LV relaxation by isovolumic relaxation time (IVRT). Results Compared with patients with appropriate LV hypertrophy (aLVH), thos e with iLVH had higher body mass index, LV mass index, relative wall thickn ess, prevalences of systolic myocardial dysfunction end prolonged IVRT and lower end-systolic stress and cardiac index. Patients with eccentric iLVH h ad the highest wall stress and lowest election fraction; 43% had systolic m yocardial dysfunction. Of patients with concentric iLVH, 79% had systolic m yocardial dysfunction but normal ejection fraction and the lowest wall stre ss. Systolic myocardial dysfunction was present in 12% with concentric aLVH and none with eccentric aLVH, Prevalence of prolonged IVRT was high in all 4 groups (65% to 77%). Cardiac index was similarly lower with concentric o r eccentric iLVH then with aLVH. Conclusions Among hypertensives with LV hypertrophy, iLVH identified cardia c phenotypes with a high prevalence of myocardial systolic dysfunction.