Circulation, Vol 81, 25-36, Copyright © 1990 by American Heart Association
A Ganau, RB Devereux, TG Pickering, MJ Roman, PL Schnall, S Santucci, MC Spitzer and JH Laragh
The weak relation of systolic blood pressure to left ventricular mass in
hypertensive patients is often interpreted as evidence of nonhemodynamic
stimuli to muscle growth. To test the hypothesis that left ventricular
chamber size, reflecting hemodynamic volume load and myocardial
contractility, influences the development of left ventricular hypertrophy
in hypertension, we studied actual and theoretic relations of left
ventricular mass to left ventricular diastolic chamber volume, pressure and
volume load, and an index of contractility. Data were obtained from
independently measured M-mode and two-dimensional echocardiograms in 50
normal subjects and 50 untreated patients with essential hypertension. Two
indices of overall left ventricular load were assessed: total load
(systolic blood pressure x left ventricular endocardial surface area) and
peak meridional force (systolic blood pressure x left ventricular cross
sectional area). A theoretically optimal left ventricular mass, allowing
each subject to achieve mean normal peak stress, was calculated as a
function of systolic blood pressure and M-mode left ventricular
end-diastolic diameter. Left ventricular mass measured by M- mode echo
correlated better with two-dimensional echocardiogram derived left
ventricular end-diastolic volume (r = 0.56, p less than 0.001) than with
systolic blood pressure (r = 0.45, p less than 0.001) and best with total
load or peak meridional force (r = 0.68 and 0.70, p less than 0.001). In
multivariate analysis both end-diastolic volume and blood pressure were
independent predictors of systolic mass (p less than 0.001) and explained
most of its variability (R = 0.75, p less than 0.001). Theoretically
optimal left ventricular mass was more closely related to end-diastolic
volume (r = 0.72, p less than 0.001) than to systolic blood pressure (r =
0.46, p less than 0.001); thus, the relatively weak correlation between
blood pressure and optimal mass reflected the influence of left ventricular
cavity size, rather than a lack of proportionality between load and
hypertrophy. Actual and theoretically optimal left ventricular mass were
closely related (r = 0.76, p less than 0.001), indicating that left
ventricular hypertrophy in most cases paralleled hemodynamic load. Left
ventricular mass was positively related to stroke index and inversely to
contractility (as estimated by the end-systolic stress/volume index ratio),
the main determinants of left ventricular chamber volume. In multivariate
analysis, systolic blood pressure, stroke index, and the end-systolic
stress/volume index ratio were each independently related to left
ventricular mass index (all p less than 0.001, multiple R = 0.81) and
accounted for 66% of its overall variability.(ABSTRACT TRUNCATED AT 400
WORDS)
ARTICLES
Relation of left ventricular hemodynamic load and contractile performance to left ventricular mass in hypertension
Cardiovascular and Hypertension Center, New York Hospital-Cornell Medical Center, NY 10021.
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