Clinical and Experimental Hypertension, 2012; 34(7): 463-469 Copyright © Informa Healthcare USA, Inc. ISSN 1064-1963 print/1525-6006 online DOI: 10.3109/10641963.2011.618205 informa healthcare Echocardiographic Abnormalities in the Assessment of Cardiac Organ Damage in Never-Treated Hypertensive Patients Alberto Milan, Eleonora Avenatti, Elisabetta Puglisi, Sara Abram, Corrado Magnino, Diego Naso, Francesco Tosello, Ambra Fabbri, Alessandro Vairo, Paolo Mulatero, Franco Rabbia, Franco Veglio Hypertension Unit, Division of Internal Medicine, Department of Medicine and Experimental Oncology, San Giovanni Battista Hospital, University of Torino, Torino, Italy Abstract Hypertension-related cardiac organ damage, other than left ventricular (LV) hypertrophy (LVH), has been described: in particular, concentric remodeling, LV diastolic dysfunction (DD), and left atrial (LA) enlargement are significantly associated with cardiovascular morbility and mortality in different populations. This study evaluated the prevalence of these latter morphofunctional abnormalities, in never-treated essential hypertensive patients and the role of such a serial assessment of hypertensive cardiac damage in improving cardiovascular risk stratification in these patients. A total of 100 never-treated essential hypertensive subjects undenwent a complete clinical and echocardiographic evaluation. Left ventricular morphology, systolic and diastolic function, and LA dimension (linear and volume) were evaluated by echocardiography. Left ventricular hypertrophy was present in 14% of the patients, whereas concen- tric remodeling was present in 25% of the subjects. Among patients free from LV morphology abnormalities, the most frequent abnormality was LA enlargement (global prevalence 57%); the percentage of patients with at least one parameter consistent with DD was 22% in the entire population, but DD was present as the only cardiac abnormality in 1 % of our patient. Left atrial volume indexed for body surface area was the most sensitive parameter in identifying hypertension-related cardiac modification. The global prevalence of cardiac alteration reached 73% in never-treated hypertensive patients. Left ventricular remodeling and LA enlargement evaluation may grant a better assessment of car- diac organ damage and cardiovascular risk stratification of hypertensive patients without evidence of LVH after routine examination. Keywords: hypertension, left ventricular hypertrophy, left atrial volume, concentric remodeling INTRODUCTION Hypertension is the main risk factor for adverse cardio- vascular and cerebrovascular events in both industrial- ized and developing countries (1). Current European Hypertension Guidelines (2) underline identification of target organ damage as a key point in the risk stratifi- cation strategy for hypertensive patients because of its prognostic values (2). Left ventricular (LV) hypertrophy (LVH) is a powerful independent risk factor for heart failure and cardiovascular events (3,4), and the main recog- nized marker of hypertension-related cardiac damage. Nevertheless, the echo examination can provide addi- tional information on cardiac structure and functions, such as the degree of left atrial (LA) enlargement (LAe), LV concentric remodeling (CR), and diastolic dysfunction (DD). All of these may be related to hypertension and their identification may improve patients' risk stratification. Left ventricular CR has a significant cardiovascular impact (3,5) even in the absence of an increased LV mass (LVH). Left atrial enlargement is associated with an increased risk of atrial fibrillation (6), and LAe is a well-established marker of DD, especially in hyperten- sive populations (7). Among different parameters able to detect and describe LAe, it has been demonstrated that LA volume indexed for body surface area (LAVi) is a powerful prognostic marker of stroke (8) and global mortality (9,10). Previous studies (3) suggested an increased cardiovascular risk associated with CR. Address correspondence to Alberto Milan, MD, PhD, Hypertension Unit, Division of Internal Medicine, Department of Medicine and Experimental Oncology, San Giovanni Battista Hospital, University of Torino, Via Genova 3, Torino, Italy. E-mail: alberto.milan@unito.it Received 13 May 2011; revised 26 May 2011; accepted 6 June 2011. 463