Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study

Journal of Human Hypertension volume 18, pages 431–436 (2004)Cite this article

Abstract

Mild-to-moderate aortic and mitral regurgitation are frequently detected by echocardiogram in asymptomatic hypertensive patients. Our goal was to assess the prevalence and impact of mild-to-moderate mitral and/or aortic regurgitation on left ventricular (LV) structure and function in patients with hypertension and LV hypertrophy (LVH). Hypertensive patients with ECG LVH enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy were evaluated. Among 939 patients with needed LV measurements and Doppler data, 242 had mild (1+) valvular regurgitation, and 51 patients had moderate (2+ or 3+) regurgitation of one or both valves. In analyses adjusting for gender, patients with mild mitral and/or aortic regurgitation had larger LV internal dimensions (5.25 vs 5.33 cm, P<0.05), higher LV mass indexed for body surface area (122 vs 125 g/m2, P<0.05) or height2.7 (55.4 vs 57.3, P<0.05), and larger left atrial diameter. Patients with moderate regurgitation of one or both valves had larger LV chambers (5.25 vs 5.9 cm, P<0.001), greater mean LV mass (232 vs 248 g, P<0.001) and LV mass indexed for body surface area or height2.7, and higher Doppler stroke volume. Patients with moderate valvular regurgitation also had a higher prevalence of LVH due to an increased prevalence of eccentric LVH. There were no differences among groups defined by the presence and severity of valvular regurgitation in cardiac output, total peripheral resistance, or pulse pressure/stroke volume, indicating that the observed inter-group differences in LV geometry were not due to differences in the haemodynamic severity of hypertension. Hypertensive patients with mild-to-moderate mitral or aortic valvular insufficiency have additional LV structural and functional changes that may affect prognosis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Levy D et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322: 1561–1566.

    Article  CAS  Google Scholar 

  2. Casale PN et al. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med 1986; 105: 173–178.

    Article  CAS  Google Scholar 

  3. Haider AW, Larson MG, Benjamin EJ, Levy D . Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death. J Am Coll Cardiol 1998; 32: 1454–1459.

    Article  CAS  Google Scholar 

  4. Singh JP et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999; 83: 897–902.

    Article  CAS  Google Scholar 

  5. Lebowitz NE et al. Prevalence and correlates of aortic regurgitation in American Indians: the Strong Heart Study. J Am Coll Cardiol 2000; 36: 461–467.

    Article  CAS  Google Scholar 

  6. Jones EC et al. Prevalence and correlates of mitral regurgitation in a population-based sample (the Strong Heart Study). Am J Cardiol 2001; 87: 298–304.

    Article  CAS  Google Scholar 

  7. Palmieri V et al. Aortic root dilatation at sinuses of valsalva and aortic regurgitation in hypertensive and normotensive subjects: the Hypertension Genetic Epidemiology Network Study. Hypertension 2001; 37: 1229–1235.

    Article  CAS  Google Scholar 

  8. Singh RG et al. Severe mitral regurgitation due to mitral valve prolapse: risk factors for development, progression, and need for mitral valve surgery. Am J Cardiol 2000; 85: 193–198.

    Article  CAS  Google Scholar 

  9. Waller BF et al. Frequency and significance of M-mode echocardiographic evidence of mitral valve prolapse in clinically isolated pure mitral regurgitation: analysis of 65 patients having mitral valve replacement. Am J Cardiol 1984; 53: 139–147.

    Article  CAS  Google Scholar 

  10. Dahlof B et al. Characteristics of 9194 patients with left ventricular hypertrophy: the LIFE study. Losartan Intervention For Endpoint Reduction in Hypertension. Hypertension 1998; 32: 989–997.

    Article  CAS  Google Scholar 

  11. Dahlof B et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003.

    Article  CAS  Google Scholar 

  12. Devereux RB et al. Relations of left ventricular mass to demographic and hemodynamic variables in American Indians: the Strong Heart Study. Circulation 1997; 96: 1416–1423.

    Article  CAS  Google Scholar 

  13. Devereux RB et al. Effects of once-daily angiotensin-converting enzyme inhibition and calcium channel blockade-based antihypertensive treatment regimens on left ventricular hypertrophy and diastolic filling in hypertension: the prospective randomized enalapril study evaluating regression of ventricular enlargement (preserve) trial. Circulation 2001; 104: 1248–1254.

    Article  CAS  Google Scholar 

  14. Wachtell K et al. Impact of different partition values on prevalences of left ventricular hypertrophy and concentric geometry in a large hypertensive population: the LIFE Study. Hypertension 2000; 35: 6–12.

    Article  CAS  Google Scholar 

  15. Devereux RB et al. Echocardiographic left ventricular geometry in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE Study. Blood Press 2001; 10: 74–82.

    Article  CAS  Google Scholar 

  16. Cooper JW, Nanda NC, Philpot EF, Fan P . Evaluation of valvular regurgitation by color Doppler. J Am Soc Echocardiogr 1989; 2: 56–66.

    Article  CAS  Google Scholar 

  17. Miyatake K et al. Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique. J Am Coll Cardiol 1986; 7: 82–88.

    Article  CAS  Google Scholar 

  18. Devereux RB et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.

    Article  CAS  Google Scholar 

  19. Palmieri V et al. Reliability of echocardiographic assessment of left ventricular structure and function: the PRESERVE study. Prospective Randomized Study Evaluating Regression of Ventricular Enlargement. J Am Coll Cardiol 1999; 34: 1625–1632.

    Article  CAS  Google Scholar 

  20. Roman MJ et al. Association of carotid atherosclerosis and left ventricular hypertrophy. J Am Coll Cardiol 1995; 25: 83–90.

    Article  CAS  Google Scholar 

  21. Ganau A et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550–1558.

    Article  CAS  Google Scholar 

  22. Teichholz LE, Kreulen T, Herman MV, Gorlin R . Problems in echocardiographic volume determinations: echocardiographic–angiographic correlations in the presence of absence of asynergy. Am J Cardiol 1976; 37: 7–11.

    Article  CAS  Google Scholar 

  23. Gutgesell HP, Paquet M, Duff DF, McNamara DG . Evaluation of left ventricular size and function by echocardiography. Results in normal children. Circulation 1977; 56: 457–462.

    Article  CAS  Google Scholar 

  24. Wachtell K et al. Effect of electrocardiographic left ventricular hypertrophy on left ventricular systolic function in systemic hypertension (The LIFE Study) Losartan Intervention For Endpoint. Am J Cardiol 2001; 87: 54–60.

    Article  CAS  Google Scholar 

  25. de Simone G et al. Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol 1994; 23: 1444–1451.

    Article  CAS  Google Scholar 

  26. Municino A et al. Assessment of left ventricular function by meridional and circumferential end-systolic stress/minor-axis shortening relations in dilated cardiomyopathy. Am J Cardiol 1996; 78: 544–549.

    Article  CAS  Google Scholar 

  27. Shimizu G et al. Left ventricular midwall mechanics in systemic arterial hypertension. Myocardial function is depressed in pressure-overload hypertrophy. Circulation 1991; 83: 1676–1684.

    Article  CAS  Google Scholar 

  28. Gaasch WH et al. Stress-shortening relations and myocardial blood flow in compensated and failing canine hearts with pressure-overload hypertrophy. Circulation 1989; 79: 872–883.

    Article  CAS  Google Scholar 

  29. Bella JN et al. Gender difference in diastolic function in hypertension (the HyperGEN study). Am J Cardiol 2002; 89: 1052–1056.

    Article  Google Scholar 

  30. Bella JN et al. Mitral ratio of peak early to late diastolic filling velocity as a predictor of mortality in middle-aged and elderly adults: the Strong Heart Study. Circulation 2002; 105: 1928–1933.

    Article  Google Scholar 

  31. Shen WF et al. Prognostic significance of Doppler-derived left ventricular diastolic filling variables in dilated cardiomyopathy. Am Heart J 1992; 124: 1524–1533.

    Article  CAS  Google Scholar 

  32. Nishimura RA et al. Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol 1996; 28: 1226–1233.

    Article  CAS  Google Scholar 

  33. Appleton CP, Hatle LK, Popp RL . Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988; 12: 426–440.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Paulette A Lyle for assistance with preparation of the manuscript.

Author information

Authors and Affiliations

  1. VA Medical Center, Washington, DC

    J Kontos & V Papademetriou

  2. Copenhagen County University Hospital, Glostrup, Denmark

    K Wachtell

  3. Weill Medical College of Cornell University, New York, NY, USA

    K Wachtell, V Palmieri, J E Liu & R B Devereux

  4. Haukeland University Hospital, Bergen, Norway

    E Gerdts

  5. Skelleftå University Hospital, Skelleftå, Sweden

    K Boman

  6. Helsinki University Central Hospital, Helsinki, Finland

    M S Nieminen

  7. Sahlgrenska University Hospital/Östra, Göteborg, Sweden

    B Dahlöf

Authors
  1. J Kontos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V Papademetriou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Wachtell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V Palmieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J E Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E Gerdts
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K Boman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M S Nieminen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B Dahlöf
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R B Devereux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V Papademetriou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kontos, J., Papademetriou, V., Wachtell, K. et al. Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study. J Hum Hypertens 18, 431–436 (2004). https://doi.org/10.1038/sj.jhh.1001715

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001715

Keywords

This article is cited by

Search

Advanced search

Quick links