title: Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients: the Losartan Intervention For Endpoint reduction in hypertension study.
abstract: BACKGROUND
  Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients.
  
  
  RESULTS
  Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area ≥116 g/m in men and ≥96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05).
  
  
  CONCLUSIONS
  The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.
authors.affiliation: aDepartment of Medicine, Weill Cornell Medical College, New York, USA bDepartment of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark cDepartment of Clinical Science, University of Bergen dDepartment of Heart Disease, Haukeland University Hospital, Bergen, Norway eDivision of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA fInstitution of Public Health and Clinical Medicine, Umeå University, Medicine Skellefteå, Umeå gDepartment of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden hDepartment of Medicine, Glostrup Hospital, Glostrup, Denmark.
authors.forename: Casper N
authors.initials: CN
authors.lastname: Bang
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Aurigemma
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D015992:Body Mass Index; D004106:Dilatation; D004311:Double-Blind Method; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013599:Systole / Q000187:drug effects; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents; D019808:Losartan