Impact of coronary artery disease on left ventricular systolic function and geometry in hypertensive patients with left ventricular hypertrophy (the LIFE study)

Hypertensive patients with left ventricular (LV) hypertrophy have a higher incidence of cardiovascular events than those without it. We hypothesized t hat a close relation exists between clinical evidence of coronary :artery d isease (CAD) and alterations in LV structure and function that contribute t o their higher risk. Echocardiograms were recorded in 963 hypertensive pati ents (mean age 66 +/- 7 years, 41% women) with electrocardiographic LV hype rtrophy, and divided into 149 with and 814 without clinical (prior myocardi al infarction or angina pectoris) or electrocardiographic (Minnesota codes 1.1, 1.2) evidence of CAD. Patients with CAD had larger LV internal dimensi ons (5.5 +/- 0.6 vs 5.2 +/- 0.5 cm), increased LV mass (136 +/- 31 vs 122 /- 24 g/m(2), and 62.4 +/- 19.4 vs 55.5 +/- 12.1 g/m(2.7)), lower ejection fraction (58 +/- 10% vs 62 +/- 8%), higher circumferential end-systolic wal l stress (cESS) (198 +/- 59 vs 181 +/- 47 kdynes/cm(2), all p <0.001), and higher total peripheral resistances (2,088 +/- 628 vs 1,963 +/- 553 dynes . s m(2)/cm(3), p = 0.02). Although eccentric IV hypertrophy predominated, t he CAD group had a greater prevalence of this geometric pattern than the no n-CAD group (56% vs 47%, p <0.02). An index of myocardial oxygen demand per beat-the IV mass . cESS . ejection time-was 20% higher in patients with CA D. In conclusion, clinical evidence of CAD in hypertensive patients with el ectrocardiographic evidence of LV hypertrophy identifies subjects with stru ctural and functional abnormalities at high risk for cardiovascular events. LV mass . cESS. ejection time, a noninvasive index that parallels myocardi al oxygen demand per beat, is especially high in hypertensive patients with CAD. (C) 2001 by Excerpta Medica, Inc.