Extracardiac organ damage in essential hypertensives with left ventricular concentric remodelling.
Clinical and prognostic values of left ventricular concentric remodelling (LVCR) are based on definition of this cardiac phenotype according to outdated guidelines indications. Thus, we analysed the association of extracardiac organ damage (OD) and LVCR (relative wall thickness >42) as defined by updated diagnostic criteria. Subclinical OD was searched in 1906 patients treated and untreated in essential hypertensives with normal echocardiographic LVMI as defined by two sets of gender-specific criteria based on LV mass (LVM) indexed to body surface area (125 g m(-2) in men and 110 g m(-2) in women) and height(2.7) (49 g m(-2.7) in men and 45 g m(-2.7) in women). Overall, 568 patients (29.8%), fulfilled the criteria for LVCR. Prevalence rates of carotid plaque, carotid intima-media (IM) thickening, grade II retinopathy and microalbuminuria (MA) were significantly higher in patients with LVCR compared with those with normal geometry (53, 24, 22, 10% versus 38, 15, 15, 7%, respectively, P<0.01, at least). Furthermore, an independent association between LVCR and continuous variables of OD such as carotid IM thickness (P<0.0001) and MA (P=0.004) was confirmed by a multivariate analysis. Our results indicate that LVCR identified by updated, less conservative, diagnostic criteria, is strongly associated with subclinical vascular and renal alterations of adverse prognostic significance. These findings support the view that LVCR should be searched for and regarded as a marker of target OD with an additional value for cardiovascular risk stratification in patients with normal LVM.
Cuspidi
C
C
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy. cesare.cuspidi@unimib.it
Giudici
V
V
Meani
S
S
Negri
F
F
Sala
C
C
Zanchetti
A
A
Mancia
G
G
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D015992:Body Mass Index; D016893:Carotid Stenosis / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012164:Retinal Diseases / Q000453:epidemiology / Q000209:etiology; D012171:Retinal Vessels / Q000000981:diagnostic imaging; D012307:Risk Factors; D012737:Sex Factors; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging; D020257:Ventricular Remodeling