[Left ventricular performance and morphologic myocardial changes in untreated hypertensive patients].

Left ventricular contractile performance and geometric adaptation to hypertension were investigated in 255 patients with untreated essential hypertension and 160 normotensive subjects by M-mode echocardiography. Because all "ejection-phase" measurements are affected by changes in afterload, ventricular performance was estimated at the operating level of systolic wall stress by the afterload-corrected fractional shortening. Mitral regurgitation was excluded in all patients by Doppler echocardiography. Patients were categorized according to values of end-diastolic relative wall thickness and left ventricular mass index. Among hypertensive patients, ventricular mass and relative wall thickness were normal in 44%, whereas 20% had increase relative wall thickness with normal ventricular mass "concentric remodeling", 22% had concentric hypertrophy (increase both ventricular mass and relative wall thickness) and 14% had increased ventricular mass with normal relative wall thickness (eccentric hypertrophy). Arterial pressure and body mass index were higher in patients with concentric hypertrophy. Left ventricular contractile performance paralleled ventricular geometry, with a decrease of the afterload-corrected fractional shortening in the group with concentric remodeling and hypertrophy, whereas systolic function was normal in the eccentric group despite higher level of systolic wall stress. This study suggests a strong dependence of left ventricular mass with chamber size and myocardial contractility. Thus arterial pressure was not the sole determinant of left ventricular hypertrophy in essential hypertension. The respective role of this factors remains to be determined.