Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy.
J Hum Hypertens. 2010 Jun;24(6):380-6. doi: 10.1038/jhh.2009.87. Epub 2009 Nov 19.
Clinical and prognostic values of left ventricular concentric remodelling (LVCR) are based on definition of this cardiac phenotype according to outdated guidelines indications. Thus, we analysed the association of extracardiac organ damage (OD) and LVCR (relative wall thickness >42) as defined by updated diagnostic criteria. Subclinical OD was searched in 1906 patients treated and untreated in essential hypertensives with normal echocardiographic LVMI as defined by two sets of gender-specific criteria based on LV mass (LVM) indexed to body surface area (125 g m(-2) in men and 110 g m(-2) in women) and height(2.7) (49 g m(-2.7) in men and 45 g m(-2.7) in women). Overall, 568 patients (29.8%), fulfilled the criteria for LVCR. Prevalence rates of carotid plaque, carotid intima-media (IM) thickening, grade II retinopathy and microalbuminuria (MA) were significantly higher in patients with LVCR compared with those with normal geometry (53, 24, 22, 10% versus 38, 15, 15, 7%, respectively, P<0.01, at least). Furthermore, an independent association between LVCR and continuous variables of OD such as carotid IM thickness (P<0.0001) and MA (P=0.004) was confirmed by a multivariate analysis. Our results indicate that LVCR identified by updated, less conservative, diagnostic criteria, is strongly associated with subclinical vascular and renal alterations of adverse prognostic significance. These findings support the view that LVCR should be searched for and regarded as a marker of target OD with an additional value for cardiovascular risk stratification in patients with normal LVM.
左心室向心性重构（LVCR）的临床和预后价值是基于根据过时的指南标准定义这种心脏表型。因此，我们分析了根据更新的诊断标准定义的心脏外器官损伤（OD）和 LVCR（相对壁厚度>42）之间的关联。在接受和未接受治疗的原发性高血压患者中，根据基于 LV 质量（LVM）与体表面积（男性为 125 g m(-2)，女性为 110 g m(-2)）和身高（2.7）的性别特异性标准（男性为 49 g m(-2.7)，女性为 45 g m(-2.7)）定义的正常 LVMI 进行超声心动图检查，寻找亚临床 OD。总体而言，568 名患者（29.8%）符合 LVCR 标准。与正常几何形状的患者相比，LVCR 患者颈动脉斑块、颈动脉内膜-中层（IM）增厚、视网膜病变 2 级和微量白蛋白尿（MA）的患病率显著更高（53%、24%、22%和 10%比 38%、15%、15%和 7%，分别，P<0.01，至少）。此外，通过多变量分析证实，LVCR 与 OD 的连续变量（颈动脉 IM 厚度，P<0.0001 和 MA，P=0.004）之间存在独立关联。我们的结果表明，根据更新的、不太保守的诊断标准确定的 LVCR 与亚临床血管和肾脏改变密切相关，这些改变具有不良预后意义。这些发现支持这样一种观点，即 LVCR 应被寻找，并被视为具有正常 LVM 的患者目标 OD 的标志物，这对于心血管风险分层具有额外价值。
