Left ventricular geometric patterns and adaptations to hemodynamics are similar in elderly men and women

BMC Cardiovascular Disorders, May 2011

Background Common conditions such as obesity and hypertension result in hemodynamic alterations that will induce remodeling of the left ventricle (LV). However, differences between the genders in the relationship of hemodynamics to LV geometry are not well known. The present study aims to investigate differences between the genders in this respect, in a sample of elderly persons. Methods Echocardiography and Doppler was performed in a population-based sample aged 70 - The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study (n = 922). Hemodynamic patterns obtained by echocardiography and Doppler were evaluated in relation to four LV geometric groups (normal, concentric remodeling, eccentric hypertrophy and concentric hypertrophy). Results No significant difference between the genders was observed regarding the prevalence of the LV geometric groups. Mean values of most evaluated echocardiography and Doppler variables differed between men and women, such as LA, IVS, LVEDD and IVRT, but the relationship of hemodynamic variables to LV geometric groups did not differ between the genders. Conclusions Although mean values of many echocardiographic variables differed between men and women, the LV geometric adaptations to a given hemodynamic load appear similar in both genders.

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Left ventricular geometric patterns and adaptations to hemodynamics are similar in elderly men and women

BMC Cardiovascular Disorders Left ventricular geometric patterns and adaptations to hemodynamics are similar in elderly men and women Said Masiha 0 Johan Sundstrm 1 Lars Lind 1 0 Department of Cardiology, Uppsala University Hospital , Uppsala , Sweden 1 Department of Internal Medicine, Uppsala University Hospital , Uppsala , Sweden Background: Common conditions such as obesity and hypertension result in hemodynamic alterations that will induce remodeling of the left ventricle (LV). However, differences between the genders in the relationship of hemodynamics to LV geometry are not well known. The present study aims to investigate differences between the genders in this respect, in a sample of elderly persons. Methods: Echocardiography and Doppler was performed in a population-based sample aged 70 - The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study (n = 922). Hemodynamic patterns obtained by echocardiography and Doppler were evaluated in relation to four LV geometric groups (normal, concentric remodeling, eccentric hypertrophy and concentric hypertrophy). Results: No significant difference between the genders was observed regarding the prevalence of the LV geometric groups. Mean values of most evaluated echocardiography and Doppler variables differed between men and women, such as LA, IVS, LVEDD and IVRT, but the relationship of hemodynamic variables to LV geometric groups did not differ between the genders. Conclusions: Although mean values of many echocardiographic variables differed between men and women, the LV geometric adaptations to a given hemodynamic load appear similar in both genders. Gender Left ventricular geometry; left ventricular hypertrophy; echocardiography; Doppler - Background Alteration of the left ventricle (LV) as a consequence of hypertension is a well known phenomenon and numerous studies have demonstrated that LV hypertrophy is a strong and independent predictor of cardiovascular events [1-4]. Several studies have demonstrated the impact of hypertension both as isolated systolic hypertension and in combination with diastolic hypertension on LV structures [5-9]. Different patterns of LV geometry as a result of hypertension were first described in a study by Ganau and coworkers in 1992 [10]. That study included 165 hypertensive and 125 middle-aged adults and described LV geometry using a combination of LV mass and the relation of muscle wall thickness to cavity size (relative wall thickness, RWT). Surprisingly, the study demonstrated that the most common LV hypertrophy (LVH) category was not the classical one, concentric hypertrophy. 52% of the hypertensive patients had a completely normal LV mass and RWT. 13% had a normal LV mass, but increased RWT and were classified as concentric remodeling. Of the remaining persons 27% had an eccentric LV hypertrophy and only 8% had concentric LVH. Furthermore, it was shown that different types of LV geometrical adaptations were associated with different hemodynamic patterns. A 10-year follow-up of 253 persons with initially uncomplicated essential hypertension revealed that persons with concentric LV geometry had the highest risk for cardiovascular death (31%) and morbid events (11%). The lowest risk was observed in the group with normal LV geometry (no cardiovascular event and 11% risk for morbid events) [10]. Andrn and co-workers investigated a populationbased sample of 584 elderly men [11]. Alterations in LV geometry were observed in both elderly men and in those with hypertension or coronary heart disease, but were more pronounced in the latter group. The prevalence of persons with normal as opposed to hypertrophic LV was different in these two studies. In addition to different hemodynamic patterns the geometric groups often have different clinical backgrounds. Persons with coronary heart disease and cardiomyopathy tend to have a higher prevalence of eccentric LVH. Concentric LVH is observed more often in persons with hypertension or valvular disease (aortic stenosis) and patients with diabetes or metabolic syndrome tend to have a higher prevalence of concentric remodeling [12,13] A study by Krumholz and co-workers demonstrated the association of isolated hypertension with increased left ventricular mass in men and women, the geometric pattern of increased LV mass differed by sex. Women demonstrated mainly a pattern of concentric hypertrophy while an eccentric pattern mainly was observed in men [14]. Thus, few studies have reported gender differences in proportions of LV geometric patterns in the general population. Our primary aim in the present study was therefore to study gender differences in the prevalence of LV geometric groups. A secondary aim was to investigate differences between genders regarding hemodynamic patterns in different LV geometric groups. Methods Subjects Eligible were all subjects aged 70 living in the community of Uppsala, Sweden. The subjects were randomly chosen from the re (...truncated)


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Said Masiha, Johan Sundström, Lars Lind. Left ventricular geometric patterns and adaptations to hemodynamics are similar in elderly men and women, BMC Cardiovascular Disorders, 2011, pp. 25, 11, DOI: 10.1186/1471-2261-11-25