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Cardiovascular risk in subjects with left ventricular concentric remodeling: Does meta-analysis help reconcile inconsistent findings?

Journal of Human Hypertension volume 25, pages 575–577 (2011)Cite this article

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Classification of the different left ventricular (LV) geometric patterns, based on measurement of LV mass (LVM) and relative wall thickness (that is, the wall thickness normalized by LV chamber radius) helps identifying distinctive pathophysiologic mechanisms.1, 2 Whether or not the type of LV geometry adds to the prognostic value of increased LVM has been object of a number of clinical and epidemiological observations.3, 4 In particular, concentric LV hypertrophy (LVH) is the phenotypic condition associated with more severe hemodynamic and structural abnormalities and, is commonly assumed to be the most unfavourable cardiovascular (CV) phenotype.2 In addition to the wide evidence provided by a number of studies,3, 4 concentric LVH is characterized by an increase in LVM exceeding the compensatory needs due to the increased cardiac load,5 a condition almost invariably associated with depressed myocardial function and early diastolic dysfunction.6 Other unfavourable characteristics of concentric LV hypertrophy are the reduced coronary blood flow reserve7 and the lower myocardial mechano-energetic efficiency.8 All these characteristics, strongly support the view that concentric LVH is associated with the greatest CV risk.

Consistent with a very traditional view, concentric LV geometry might be a compensatory response to pressure overload, to reduce wall stress. However, cardiomyocyte hypertrophy and structural disarray produced by continuous pressure overload and neurohormonal activation, despite apparently protecting LV chamber function from early impairment, also cause abnormal LV systolic function and distensibility,9 visible at the midwall level.10 Thus, the ability to reduce wall stress is not a convenient consequence of concentric LV geometry11 and does not seem substantial to protect LV chamber function.12

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  1. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

    G de Simone & M De Marco

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Correspondence to G de Simone.

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de Simone, G., De Marco, M. Cardiovascular risk in subjects with left ventricular concentric remodeling: Does meta-analysis help reconcile inconsistent findings?. J Hum Hypertens 25, 575–577 (2011). https://doi.org/10.1038/jhh.2011.44

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