title: Left ventricular dilatation and subclinical renal damage in primary hypertension.
abstract: OBJECTIVE
  A new classification of left ventricular geometry based on left ventricular dilatation and concentricity has recently been developed. This classification identifies subgroups differing with regard to systemic haemodynamics, left ventricular function and cardiovascular prognosis. We investigated the relationship between the new classification of left ventricular geometry and subclinical renal damage, namely urine albumin excretion and early intrarenal vascular changes in primary hypertensive patients.
  
  
  METHODS
  A total of 449 untreated hypertensive patients were studied. Four different patterns of left ventricular hypertrophy (eccentric nondilated, eccentric dilated, concentric nondilated and concentric dilated hypertrophy) were identified by echocardiography. Albuminuria was measured as the albumin-to-creatinine ratio. Early intrarenal vascular changes, expressed as the renal volume to resistive index ratio, were evaluated by ultrasound and Doppler scan.
  
  
  RESULTS
  Patients with concentric dilated left ventricular hypertrophy had higher albumin excretion rates (P = 0.0258) and prevalence of microalbuminuria (P < 0.0001) and lower renal volume to resistive index ratio than patients with concentric nondilated hypertrophy (P = 0.0093). Patients with eccentric dilated hypertrophy showed a higher prevalence of microalbuminuria than patients with eccentric nondilated hypertrophy (P < 0.0001). Moreover, patients with chamber dilatation showed a higher prevalence of microalbuminuria (P = 0.0002) and lower renal volume to resistive index ratio (P = 0.0107) than patients without chamber dilatation. After adjusting for potentially confounding variables, left ventricular chamber dilatation was an independent predictor of subclinical renal damage.
  
  
  CONCLUSIONS
  Left ventricular dilatation is associated with subclinical renal damage in hypertension. These findings extend previous reports and provide a pathophysiological rationale for the observed unfavourable prognosis in patients with left ventricular dilatation.
authors.affiliation: I.R.C.C.S. Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Ratto
authors.forename: Francesca
authors.initials: F
authors.lastname: Viazzi
authors.forename: Barbara
authors.initials: B
authors.lastname: Bonino
authors.forename: Annalisa
authors.initials: A
authors.lastname: Gonnella
authors.forename: Debora
authors.initials: D
authors.lastname: Garneri
authors.forename: Emanuele L
authors.initials: EL
authors.lastname: Parodi
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Bezante
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Derchi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Leoncini
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis