Disproportionately High Left Ventricular Myocardial Mass in Patients With Arterial Hypertension
Background Increase of myocardial mass of left ventricle (MMLV) to a greater extent than required by hemodynamic load by elevated arterial pressure (AP) is reflected in concepts of "disproportionately" high (DH) MMLV and resistant to anti hypertensive treatment LV hypertrophy (LVH). Aim. To study in patients with arterial hypertension (AH) frequency of DH MMLV and factors associated with it. Material and methods. Patients (n=170, 70 men, age 57.6 +/- 5.9 years) with previously untreated or irregularly treated uncontrollable AH. Proportionality of MMLV was assessed by coefficient of disproportionality (CID) defined as ratio of actual to expected MMLV. Results. DH MMLV was found in 140 patients (82.4%). Frequency of ECHOCG LVH among patients with DH MMLV was 49.3%. There were no cases of LVH among patients with proportional MMLV. Frequency of LVH depended on severity of disproportionality of MMLV elevation and was 18.9% at CD 128-155.9% and 82.2% at CID >= 184%. Patients with DH MMLV were characterized by greater body mass index, higher rate of disturbances of carbohydrate and lipid metabolism. Patients with DH MMLV without compared with those with LVH were characterized by significantly higher rate of concentric variant of LV geometry (66.2 vs 40.6%, p<0.05) and diastolic dysfunction (57.7 vs 36.2%, p<0.05), lower values of parameters of systolic LV function and higher rate of combination of concentric remodelling and diastolic LV dysfunction. Conclusion. DH MMLV is frequent among patients with previously untreated or irregularly treated uncontrollable AH. Calculation of disproportionality of MMLV allows to give additional characteristic of morphofunctional state of the myocardium in patients with AH. DH MMLV is associated with complex of subclinical structurally-functional disturbances of the myocardium and unfavourable changes of carbohydrate and lipid metabolism.