Echocardiographic Partition Values and Prevalence of Left Ventricular Hypertrophy in Hypertensive Jamaicans

Abstract

Background: Left ventricular hypertrophy (LVH) detected by either electrocardiography or echocardiography has been shown to be an extremely strong predictor of morbidity and mortality in patients with essential hypertension and in members of the general population. Alternative to LVH, left ventricular geometrical patterns offer incremental prognostic value beyond that provided by the other cardiovascular risk factors including left ventricular mass (LVM). Combination of LVM and relative wall thickness (RWT) can be used to identify different left ventricular geometrical patterns. Various indexation methods normalised for LVM have been shown to offer prognostic significance. There was no prior study on the prevalence of LVH and geometric patterns in hypertensive patients in Jamaica using multiple partition values. Our study was designed to estimate the prevalence of LVH and geometrical patterns in a hypertensive Caribbean population in Jamaica using 10 different published cut-off values. Methods: Clinical and echocardiographic data were collected from 525 consecutive hypertensive patients attending the cardiology clinic of the Heart Institute of the Caribbean over a period of 24 months who met the inclusion criteria for the study. LVM was calculated using different methods of indexation for body size and different partition values (PV) to identify LVH as described below: LVM/ BSA (g/m 2 ) PVs for men/women 116/104, 125/110, 125/125, 131/100; LVM/height (g/m) PVs 143/102, 126/105; LVM/height 2.0 PV 77.5/58.0; LVM/height 2.13 PV 68/61 and LVM/height 2.7 (g/m 2.7 ) PVs 51/51 and 49.2/46.7. RWT was calculated using the formula 2 X Posterior Wall Thickness (PWT)/ Left Ventricular Internal Diameter in diastole (LVIDd). Left ventricular geometrical patterns were categorised utilising the RWT and LVM. The impact of selected indexation methods and PVs on the prevalence of LVH and geometrical patterns were analysed. Results: Complete data was obtained in 501(95.5%) of the 525 subjects (40.5% men & 59.5% women). The prevalence of LVH ranged between 19.3–38.5%. The highest prevalence of LVH was found when the LVM was indexed to the height with a partition value of 126 g/ht in men and 105 g/ht in women and height raised to the power of 2.7 with a partition value of 49.2 g/ht 2.7 in men and 46.7 g/ht 2.7 in women. Abnormal LV geometry ranged between 71.4-77.8%. Concentric remodelling was the most common type of abnormal geometry (38.5-52.1%) while the eccentric hypertrophy was the least common type (3.99-10.3%) found for all indexation methods and partition values. Concentric hypertrophy (15.3-28.9%) was the second most common type of abnormal geometry found in our patients.