SYSTEMIC HYPE Hemodynamic Hypertrophied left Ventricular Patterns in Systemic Hypertension GIOVANNI DE SIMONE, MD, LUIGI DI LORENZO, MD, DOMENICO MOCCIA, MD, GUIDO COSTANTINO, MD, SALVATORE BUONISSIMO, MD, and ORESTE DE DIVITIIS, MD The hemodynamic pattern of hypertrophied left ven- tricle in systemic hypertension was studied by M- mode echocardiography in 42 untreated hyperten- sive patients with left ventricular (LV) mass index >2 standard deviations from the sex-specific mean of 114 normal subjects (normal values of our labo- ratory), and in 45 normotensive volunteers. Hyper- tensive patients showed cardiac dimensions, rela- tive diastolic wall thickness, ratio of systolic pressure to end-systolic dimension, cardiac index and stroke index greater than normotensive control subjects (0.01 <p <O.OOOl). Pressure/dimension ratio was correlated to relative wall thickness (p <0.005). End-systolic stress/volume ratio was nor- mal as was systolic pressure to dimension ratio nor- malized for end-diastolic wall thickness. LV hyper- trophy was concentric in 26% and eccentric in 74% of patients and suggested 2 different heart ad- aptations to overload: eccentric hypertrophy was associated with increased cardiac dimensions, high peak stress, normal systolic function and moderate- ly increased LV contractility; concentric hypertrophy was associated with the highest blood pressure val- ues, normal cardiac dimension, normal peak stress, normal systolic function and much increased LV contractility. Because stress/volume ratio and wall thickness-corrected systolic pressure/dimension ra- tio were normal in hypertensive patients, LV con- tractile capacity might be supported by the increase in myocardium available for contraction, rather than by increase in inotropic state. (Am d Cardiol 1987;60:1317-1321) T he relations among systolic function, contractile state and development of left ventricular (LV] hyper- trophy are essential in the adaptation of the heart in systemic hypertension. Searching for those relations can help to understand the pathophysiologic mecha- nisms leading to heart failure, which is still one of the most frequent adverse outcomes of hypertensionl-3 and can indicate several therapeutic implications. Re- cently, Lutas et al4 showed that enhancement of systol- From the Cardiology Unit, Institute of Internal Medicine and Metabolic Diseases, Second Medical School, University of Na- ples, Naples, Italy. Supported in part by grant 1984 from the Ministry of Education. Manuscript received April 27, 1987; re- vised manuscript received and accepted July 27,1987. Dr. De Divitiis’s present address: Medical Physiopathology, Medical School, “La Sapienza” University, Rome, Italy. Address for reprints: Giovanni de Simone, MD, Cardioan- giologia, Istituto di Medicina Interna e Malattie Dismetaboliche, 2a Facolta’ di Medicina e Chirurgia, v.S.Pansini n.5, 80131 Na- poli, Italia. ic function could be found in hypertensive patients, independent of the development of supercompensa- tory LV hypertrophy; a possible increase in inotropic state could be suggested in these patients. In a previous study, Takahashi et al5 showed a decrease in contrac- tility in hypertensive patients with advanced LV hy- pertrophy. We found that primary hypertension was frequently associated with enhanced contractility in patients without echocardiographic evidence of an in- crease in LV mass, but with an increase in relative diastolic wall thickness (unpublished observations). In the present study cardiac performance in a group of untreated hypertensive patients with ascertained LV hypertrophy is assessed and the hemodynamic pattern of the hypertrophied left ventricle is evaluated. Methods Patients: Forty-two patients [16 men and 26 women) age 20 to 60 years [mean 45 f 121 with primary hyper- tension, and 45 normotensive volunteers, matched for age (43 f 10 years), sex (20 men and 25 women) and 1317