Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1977 Nov;39(11):1239–1245. doi: 10.1136/hrt.39.11.1239

Left ventricular performance in patients with left ventricular hypertrophy caused by systemic arterial hypertension.

J S Karlinger, D Williams, J Gorwit, M H Crawford, R A O'Rourke
PMCID: PMC483402  PMID: 145228

Abstract

To assess the adaptation of the left ventricle to a chronic pressure overload we used echocardiography to study 18 patients with left ventricular hypertrophy caused by systemic arterial hypertension. Increased values for either posterior wall or interventricular septal thickness or both confirmed the presence of left ventricular hypertrophy in all patients and an increase in the average wall thickness to radius ratio was consistent with the development of concentric hypertrophy. No patient had clinical evidence of ischaemic heart disease. Ejection phase indices of left ventricular performance (mean Vcf, fractional per cent of shortening, normalised posterior wall velocity, and ejection fraction) were within the normal range in the basal state in 16 of the 18 patients. The hypothesis is advanced that patients with concentric left ventricular hypertrophy resulting from systemic arterial hypertension usually have normal left ventricular performance in the basal state because values for wall stress remain within the normal range. We conclude that the hypertrophic response to a chronic increase in systemic arterial pressure does not per se result in depression of the basal inotropic state of the left ventricle.

Full text

PDF
1242

Images in this article

1240Image
on p.1240

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bing O. H., Matsushita S., Fanburg B. L., Levine H. J. Mechanical properties of rat cardiac muscle during experimental hypertrophy. Circ Res. 1971 Feb;28(2):234–245. doi: 10.1161/01.res.28.2.234. [DOI] [PubMed] [Google Scholar]
  2. Cooper G., 4th, Puga F. J., Zujko K. J., Harrison C. E., Coleman H. N., 3rd Normal myocardial function and energetics in volume-overload hypertrophy in the cat. Circ Res. 1973 Feb;32(2):140–148. doi: 10.1161/01.res.32.2.140. [DOI] [PubMed] [Google Scholar]
  3. Dodek A., Burg J. R., Kloster F. R. Systolic time intervals in chronic hypertension: Alterations and response to treatment. Chest. 1975 Jul;68(1):51–55. doi: 10.1378/chest.68.1.51. [DOI] [PubMed] [Google Scholar]
  4. Frohlich E. D., Tarazi R. C., Dustan H. P. Clinical-physiological correlations in the development of hypertensive heart disease. Circulation. 1971 Sep;44(3):446–455. doi: 10.1161/01.cir.44.3.446. [DOI] [PubMed] [Google Scholar]
  5. Gamble W. J., Phornphutkul C., Kumar A. E., Sanders G. L., Manasek F. J., Monroe R. G. Ventricular performance, coronary flow, and MVO 2 in aortic coarctation hypertrophy. Am J Physiol. 1973 Apr;224(4):877–883. doi: 10.1152/ajplegacy.1973.224.4.877. [DOI] [PubMed] [Google Scholar]
  6. Glover L., Baxley W. A., Dodge H. T. A quantitative evaluation of heart size measurements from chest roentgenograms. Circulation. 1973 Jun;47(6):1289–1296. doi: 10.1161/01.cir.47.6.1289. [DOI] [PubMed] [Google Scholar]
  7. Grant C., Greene D. G., Bunnell I. L. Left ventricular enlargement and hypertrophy. A clinical and angiocardiographic study. Am J Med. 1965 Dec;39(6):895–904. doi: 10.1016/0002-9343(65)90111-7. [DOI] [PubMed] [Google Scholar]
  8. Grossman W., Jones D., McLaurin L. P. Wall stress and patterns of hypertrophy in the human left ventricle. J Clin Invest. 1975 Jul;56(1):56–64. doi: 10.1172/JCI108079. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gunning J. F., Cooper G., 4th, Harrison C. E., Coleman H. N., 3rd Myocardial oxygen consumption in experimental hypertrophy and congestive heart failure due to pressure overload. Am J Cardiol. 1973 Sep 20;32(4):427–436. doi: 10.1016/s0002-9149(73)80033-5. [DOI] [PubMed] [Google Scholar]
  10. Hagan A. D., Francis G. S., Sahn D. J., Karliner J. S., Friedman W. F., O'Rourke R. A. Ultrasound evaluation of systolic anterior septal motion in patients with and without right ventricular volume overload. Circulation. 1974 Aug;50(2):248–254. doi: 10.1161/01.cir.50.2.248. [DOI] [PubMed] [Google Scholar]
  11. Henry W. L., Clark C. E., Epstein S. E. Asymmetric septal hypertrophy. Echocardiographic identification of the pathognomonic anatomic abnormality of IHSS. Circulation. 1973 Feb;47(2):225–233. doi: 10.1161/01.cir.47.2.225. [DOI] [PubMed] [Google Scholar]
  12. Hirshleifer J., Crawford M., O'Rourke R. A., Karliner J. S. Influence of acute alterations in heart rate and systemic arterial pressure on echocardiographic measures of left ventricular perfornmance in normal human subjects. Circulation. 1975 Nov;52(5):835–841. doi: 10.1161/01.cir.52.5.835. [DOI] [PubMed] [Google Scholar]
  13. Hood W. P., Jr, Rackley C. E., Rolett E. L. Wall stress in the normal and hypertrophied human left ventricle. Am J Cardiol. 1968 Oct;22(4):550–558. doi: 10.1016/0002-9149(68)90161-6. [DOI] [PubMed] [Google Scholar]
  14. Karliner J. S., Bouchard R. J., Gault J. H. Dimensional changes of the human left ventricle prior to aortic valve opening. A cineangiographic study in patients with and without left heart disease. Circulation. 1971 Sep;44(3):312–322. doi: 10.1161/01.cir.44.3.312. [DOI] [PubMed] [Google Scholar]
  15. Karliner J. S., Gault J. H., Eckberg D., Mullins C. B., Ross J., Jr Mean velocity of fiber shortening. A simplified measure of left ventricular myocardial contractility. Circulation. 1971 Sep;44(3):323–333. doi: 10.1161/01.cir.44.3.323. [DOI] [PubMed] [Google Scholar]
  16. LEVINE N. D., ROCKOFF S. D., BRAUNWALD E. AN ANGIOCARDIOGRAPHIC ANALYSIS OF THE THICKNESS OF THE LEFT VENTRICULAR WALL AND CAVITY IN AORTIC STENOSIS AND OTHER VALVULAR LESIONS. HEMODYNAMIC-ANGIOGRAPHIC CORRELATIONS IN PATIENTS WITH OBSTRUCTION TO LEFT VENTRICULAR OUTFLOW. Circulation. 1963 Sep;28:339–345. doi: 10.1161/01.cir.28.3.339. [DOI] [PubMed] [Google Scholar]
  17. LINZBACH A. J. Heart failure from the point of view of quantitative anatomy. Am J Cardiol. 1960 Mar;5:370–382. doi: 10.1016/0002-9149(60)90084-9. [DOI] [PubMed] [Google Scholar]
  18. Malik A. B., Abe T., O'Kane H. O., Geha A. S. Cardiac performance in ventricular hypertrophy induced by pressure and volume overloading. J Appl Physiol. 1974 Dec;37(6):867–874. doi: 10.1152/jappl.1974.37.6.867. [DOI] [PubMed] [Google Scholar]
  19. Meerson F. Z. The myocardium in hyperfunction, hypertrophy and heart failure. Circ Res. 1969 Jul;25(1 Suppl):1–163. [PubMed] [Google Scholar]
  20. Mehmel H. C., Mazzoni S., Krayenbuehl H. P. Contractility of the hypertrophied human left ventricle in chronic pressure and volume overload. Am Heart J. 1975 Aug;90(2):236–240. doi: 10.1016/0002-8703(75)90125-8. [DOI] [PubMed] [Google Scholar]
  21. Pfeffer M. A., Pfeffer J. M., Frohlich E. D. Pumping ability of the hypertrophying left ventricle of the spontaneously hypertensive rat. Circ Res. 1976 May;38(5):423–429. doi: 10.1161/01.res.38.5.423. [DOI] [PubMed] [Google Scholar]
  22. Pombo J. F., Troy B. L., Russell R. O., Jr Left ventricular volumes and ejection fraction by echocardiography. Circulation. 1971 Apr;43(4):480–490. doi: 10.1161/01.cir.43.4.480. [DOI] [PubMed] [Google Scholar]
  23. Popp R. L., Filly K., Brown O. R., Harrison D. C. Effect of transducer placement on echocardiographic measurement of left ventricular dimensions. Am J Cardiol. 1975 Apr;35(4):537–540. doi: 10.1016/0002-9149(75)90837-1. [DOI] [PubMed] [Google Scholar]
  24. Quinones M. A., Gaasch W. H., Alexander J. K. Echocardiographic assessment of left ventricular function with special reference to normalized velocities. Circulation. 1974 Jul;50(1):42–51. doi: 10.1161/01.cir.50.1.42. [DOI] [PubMed] [Google Scholar]
  25. Ratshin R. A., Rackley C. E., Russell R. O., Jr Determination of left ventricular preload and afterload by quantitative echocardiography in man. Circ Res. 1974 May;34(5):711–718. doi: 10.1161/01.res.34.5.711. [DOI] [PubMed] [Google Scholar]
  26. Romhilt D. W., Estes E. H., Jr A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J. 1968 Jun;75(6):752–758. doi: 10.1016/0002-8703(68)90035-5. [DOI] [PubMed] [Google Scholar]
  27. Ross J., Jr Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis. 1976 Jan-Feb;18(4):255–264. doi: 10.1016/0033-0620(76)90021-9. [DOI] [PubMed] [Google Scholar]
  28. Sasayama S., Ross J., Jr, Franklin D., Bloor C. M., Bishop S., Dilley R. B. Adaptations of the left ventricle to chronic pressure overload. Circ Res. 1976 Mar;38(3):172–178. doi: 10.1161/01.res.38.3.172. [DOI] [PubMed] [Google Scholar]
  29. Simon H., Krayenbuehl H. P., Rutishauser W., Preter B. O. The contractile state of the hypertrophied left ventricular myocardium in aortic stenosis. Am Heart J. 1970 May;79(5):587–602. doi: 10.1016/0002-8703(70)90278-4. [DOI] [PubMed] [Google Scholar]
  30. Spann J. F., Jr, Buccino R. A., Sonnenblick E. H., Braunwald E. Contractile state of cardiac muscle obtained from cats with experimentally produced ventricular hypertrophy and heart failure. Circ Res. 1967 Sep;21(3):341–354. doi: 10.1161/01.res.21.3.341. [DOI] [PubMed] [Google Scholar]
  31. Spann J. F., Jr, Covell J. W., Eckberg D. L., Sonnenblick E. H., Ross J., Jr, Braunwald E. Contractile performance of the hypertrophied and chronically failing cat ventricle. Am J Physiol. 1972 Nov;223(5):1150–1157. doi: 10.1152/ajplegacy.1972.223.5.1150. [DOI] [PubMed] [Google Scholar]
  32. Spann J. F., Jr, Mason D. T., Zelis R. F. The altered performance of the hypertrophied and failing heart. Am J Med Sci. 1969 Nov;258(5):291–303. doi: 10.1097/00000441-196911000-00002. [DOI] [PubMed] [Google Scholar]
  33. Toshima H., Koga Y., Yoshioka H., Akiyoshi T., Kimura N. Echocardiographic classification of hypertensive heart disease. A correlative study with clinical features. Jpn Heart J. 1975 Jul;16(4):377–393. doi: 10.1536/ihj.16.377. [DOI] [PubMed] [Google Scholar]
  34. Williams J. F., Jr, Potter R. D. Normal contractile state of hypertrophied myocardium after pulmonary artery constriction in the cat. J Clin Invest. 1974 Dec;54(6):1266–1272. doi: 10.1172/JCI107871. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES