Echocardiographic left ventricular hypertrophy in hypertension: marker for future events or mediator of events?
OBJECTIVE
To discuss the most relevant studies on the prognostic impact of echocardiographic left ventricular hypertrophy in hypertension.


RESULTS
There is abundant evidence from epidemiological studies that increased left ventricular mass identifies hypertensive patients at increased risk of major cardiac and cerebrovascular events. Looking at the geometric patterns of the left ventricle, concentric remodelling and concentric left ventricular hypertrophy carry the highest risk for adverse events. Patients with left ventricular hypertrophy reversal as an effect of treatment are exposed to a lesser risk of events as compared with patients with persistence of left ventricular hypertrophy. Reversal of concentric remodelling predicts a lesser risk of adverse events compared with persistence of remodelling. Experimental evidence is accumulating that several haemodynamic and nonhaemodynamic factors which are able to promote progression of atherosclerosis through plaque growth and destabilization may also induce left ventricular hypertrophy by acting on myocyte and interstitium. Increased left ventricular mass may also be a causative factor for reduced pumping performance and arrhythmias.


CONCLUSIONS
Increased left ventricular mass is a marker of cardiovascular risk because it reflects and integrates the long-term level of activity of factors inducing progression of atherosclerosis. Increased left ventricular mass may also mediate myocardial ischaemia with potential evolution towards heart failure and arrhythmias.
Verdecchia
Paolo
P
Hospital S. Maria della Misericordia, Division of Cardiology, Clinical Research Unit Preventive Cardiology, Perugia, Italy. verdec@tin.it
Angeli
Fabio
F
Achilli
Paola
P
Castellani
Claudia
C
Broccatelli
Andrea
A
Gattobigio
Roberto
R
Cavallini
Claudio
C
D050197:Atherosclerosis / Q000209:etiology; D015415:Biomarkers; D004452:Echocardiography; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D011379:Prognosis; D020257:Ventricular Remodeling
D015415:Biomarkers