Hemodynamic and Functional Correlates of Concentric versus Eccentric LVH in a Community-Based Sample with Prevalent Volume-Dependent Hypertension.

BACKGROUND Whether in populations with prevalent volume-dependent primary hypertension, concentric left ventricular (LV) remodelling beyond hypertrophy (LVH) represents the impact of a pressure rather than a volume overload, is unclear. METHODS Using central arterial pressure, and aortic velocity and diameter measurements in the outflow tract and echocardiography, we determined the factors that associate with concentric LVH or remodelling in the LV short axis in a community of African ancestry (n=709) with prevalent volume-dependent primary hypertension. RESULTS Both left ventricular mass index (LVMI) and RWT were positively and independently associated with end diastolic volume (EDV), stroke volume (SV) and peak aortic flow (Q) (p<0.05 to <0.0001). However, neither LVMI nor RWT were positively and independently associated with systemic vascular resistance (SVR), or aortic characteristic impedance (Zc) or inversely associated with total arterial compliance (TAC). Consequently, both concentric (p<0.0001) and eccentric (p<0.0001) LVH were associated with similar increases in EDV, SV, and either office brachial, central arterial or 24-hour blood pressures, but neither increases in SVR or Zc nor decreases in TAC. Left ventricular RWT, but not LVMI was nevertheless independently and inversely associated with myocardial systolic function (midwall fractional shortening and LV wall myocardial shortening velocity [s']) (p<0.05 to <0.005) and decreases in LV systolic function were noted in concentric (p<0.05), but not eccentric LVH. CONCLUSIONS In volume-dependent primary hypertension, concentric LVH is determined as much by volume-dependent increases in systemic flow and an enhanced BP as eccentric LVH. Concentric remodelling nevertheless reflects decreases in systolic function beyond LVH.