Predictors of Left Ventricular Hypertrophy in Hypertensive Patients with Normal ECG

Abstract

Introduction: Early identification of left ventricular hypertrophy (LVH) in hypertensive patients is of great importance for correct stratification of cardiovascular (CV) risk. It is well known that ECGhas low sensibility in detecting LVH, while echocardiography, for organizational difficulties, cannot be performed routinely. Aim: To evaluate the prevalence of LVH and of anomalies of diastolic function in a group of hypertensive patients free of diabetes, CV diseases, and with normal ECG. Methods: We excluded patients with CV diseases, diabetes, chronic kidney disease (CKD), or having ECG-LVH or other ECG anomalies. Then, we enrolled 310 hypertensive patients (mean age 48 years). All enrolled subjects underwent echocardiographic examination (Acuson Sequoia 512). LV mass was indexed by body surface area (LVMI) and LVHwas defined as LVMI >125 g/m2 in men and >110 g/m2 in women. Diastolic function was evaluated by mitral inflow and Tissue Doppler Imaging (TDI). Results: Patients with LVH had higher age and duration of hypertension when compared with patients without LVH (p = 0.002 and <0.0001, respectively). Prevalence of LVH in the whole sample was 8.18%; among these patients, 77.7% had concentric LVH. The analysis was then repeated in each sex: 6% of males and 11.6% of females had LVH. Concentric geometry was highly prevalent both in males (75%) and females (80%). Mean value of LVMI was 91.48 – 19.19 g/m2 in the whole sample and 129– 10.79 g/m2 in the subgroup with LVH(135.5 – 7.84 g/m2 in males and 123.8– 10.1 g/m2 in females with LVH). Further, we evaluated the mean difference of LVMI from the cut-off value for LVH: it was 12.3 – 9.19 g/m2 in the whole group, 10.5 – 7.84 g/m2 in males and 13.8– 10.1 g/m2 in females.Multiple regression analysis showed that the variables independently associated with the presence of LVH were age and duration of hypertension (p< 0.001).Diastolic dysfunction, defined as early diastolicmyocardial velocity (Em) <0.08m/sec, was found only in 3.2% of patients. Conclusions: The prevalence of LVH among hypertensive patients with normal ECG, and free of diabetes, CV diseases and CKD is low (8.18%); further, patients with echocardiographic LVH had LVMI values that generally identified mild forms of LVH, accompanied only in very few cases by anomalies of diastolic function. In hypertensive patientswith such characteristics, the echocardiographic examination should probably be reserved to older patients or with higher duration of hypertension