From Left Ventricular Hypertrophy to Congestive Heart Failure: Management of Hypertensive Heart Disease
Section snippets
Incidence and Prevalence
Criteria used to define LVH both by electrocardiogram (ECG) and echocardiography are not uniform and vary substantially among studies. Estimates of left ventricular mass (LVM)are conventionally indexed to body size, yielding a value for LVM index (LVMI) in grams per square meter if corrected for body surface area or grams per meter if corrected for height. Hammond et al3 has suggested that 134 g/m2 in men and 110 g/m2 in women are suitable LVMI threshold values for defining LVH in a
Factors in LVH Development
Left ventricular hypertrophy is an adaptive response of the myocardium to increased cardiac workload; its development normalizes wall tension and is thought to preserve systolic ventricular function. The incidence of LVH is directly related to the level of systolic BP.20, 21, 22, 23, 24 The relationship between the age-adjusted prevalence of LVH, as determined by echocardiography and average systolic BP in the Framingham study, is shown in Fig 1. Although a linear relationship to BP is
Structural Alterations
The myocardium is an elastic network of myocytes enmeshed in a collagen matrix that connects the myocytes and supporting coronary vasculature (Fig 2).31
The cardiac anatomical changes that accompany chronic elevation of systolic and diastolic BP are commonly referred to by the term left ventricular hypertrophy. It is important to keep in mind, however, that the remodeling process, which accompanies hypertension, consists of a range of changes in tissue architecture, which include perivacular and
Prevention
Treatment of hypertension greatly attenuates the development of LVH and heart failure. In a meta-analysis by Moser and Herbert66 reviewing major hypertension trials conducted over a 20-year period and involving more than 48 000 subjects, ECG-LVH was reduced by about one third and heart failure by 52%. The type of heart failure—systolic vs diastolic—was not specified. It is likely that these figures underestimate the potential of aggressive antihypertensive therapy. Target BPs in many of these
Summary
Left ventricular hypertrophy is an adaptive response of the heart to hypertension, which results in changes in myocardial structure that greatly increase the risks of cardiovascular mortality, sudden death, coronary heart disease, heart failure, and stroke. Ischemia, ventricular arrhythmias and diastolic dysfunction are the functional components of hypertensive heart disease. Myocardial fibrosis appears to be the most important structural alteration in its development. Although elevated BP is
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