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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
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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)