The influence of the left ventricular geometry on the left atrial size and left ventricular filling pressure in hypertensive patients, as assessed by echocardiography

Abstract

Background and objectives: It is not well understood whether the left ventricular geometry is associated with such diastolic parameters as the left atrial volume and the left ventricular filling pressure, as assessed by the Doppler indices. Accordingly, this study aimed to evaluate the influence of the left ventricular geometry on the left atrial volume and the left ventricular filling pressure, as assessed by the Doppler indices.

Subjects and methods: 181 patients (mean age: 63+/-9 years old, 62 males) with hypertension were included for echocardiographic analysis. The hypertensive patients were classified into four groups according to the left ventricular mass index and the relative wall thickness: normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. We excluded all the individuals with established cardiovascular disease, atrial fibrillation, significant aortic and/or mitral valve disease, or an ejection fraction <50%.

Results: By definition, the left ventricular mass was increased in the patients with eccentric and concentric hypertrophy. Both the left ventricular end-systolic diameter and the left ventricular end-diastolic diameter were reduced in the concentric remodeling group, whereas the left ventricular end-systolic diameter and the left ventricular end-diastolic diameter were increased in the eccentric and concentric hypertrophy groups. Compared with the patients with normal geometry, the patients with eccentric and concentric hypertrophy demonstrated a significant higher value for the left atrial volume index. The ratio of the transmitral inflow velocity to the mitral annular velocity (E/E') showed a stepwise increase from the patients with normal geometry to the patients with concentric remodeling, and then to the patients with eccentric and concentric hypertrophy.

Conclusion: This study demonstrates that in a patient population with hypertension and who are without systolic dysfunction, the left atrial volume index and the E/E' demonstrated a progressive worsening of the left ventricular diastolic function from patients with normal geometry to the patients with concentric remodeling, and then to the patients with eccentric and concentric hypertrophy.

Keywords: Doppler echocardiography; Hypertension; Left atrium; Ventricular remodeling.

Fig. 1

Measurement of the mitral inflow velocities by pulsed-wave Doppler (A) and measurement of the mitral annular velocity by pulsed-wave Doppler tissue imaging (B). E: early diastolic mitral inflow velocity, A: late diastolic mitral inflow velocity, DT: deceleration time, E': early diastolic mitral annular tissue velocity, A': late diastolic mitral annular tissue velocity.

Fig. 2

The relationship of the left ventricular geometric pattern to the left atrial volume index.

Fig. 3

The relationship of the left ventricular geometric pattern to the E/E'. E/E: the ratio of the transmitral inflow velocity to the mitral annular velocity.