CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 1, January/February 2010
AFRICA
21
Cardiovascular Topics
Relationship between left ventricular geometric pattern
and systolic and diastolic function in treated Nigerian
hypertensives
ADESEYE A AKINTUNDE, OLURANTI B FAMILONI, PATIENCE O AKINWUSI, O GEORGE OPADIJO
Summary
Introduction:
Despite a high worldwide prevalence of left
ventricular hypertrophy among black patients, the associa-
tion of a specific left ventricular geometric pattern with left
ventricular dysfunction is rare. The aim of this study was
to explore the possibility of such an association in Nigerian
hypertensives.
Methods:
This was a retrospective study consisting of 188
treated hypertensives. Echocardiography was used to allocate
the patients to the following four groups: normal geometric
pattern, concentric remodelling, eccentric hypertrophy and
concentric hypertrophy.
Results:
Themeanageof the studypopulationwas 55.95
±
10.71
years. There were 75 females (39.9%). Concentric hypertro-
phy occurred in 72 (38.3%) patients and concentric remodel-
ling in 53 (28.2%). Only 30 (16%) had a normal left ventricu-
lar geometric pattern. Hypertensive subjects with eccentric
hypertrophy had the lowest ejection fraction, fractional fibre
shortening and left ventricular ejection time but these did
not reach statistical significance. The mean left atrial dimen-
sion was highest in the subjects with eccentric hypertrophy.
Conclusion:
In this study population of treated Nigerian
hypertensives, concentric remodelling and hypertrophy were
the predominant left ventricular geometrical patterns.
Keywords:
hypertension, left ventricular hypertrophy, geometric
pattern, systolic and diastolic function, association
Submitted 12/2/09, accepted 29/6/09
Cardiovasc J Afr
2010;
21
: 21–25
Left ventricular hypertrophy is an important determinant of
adverse cardiovascular events in subjects with hypertension.
1
Racial predilection and associated cardiovascular disorders
have been described, especially among blacks and African-
Americans.
1,2
Left ventricular hypertrophy (LVH) is associated
with increased prevalence of heart failure (both systolic and
diastolic), aortic root dilation, arrhythmias, sudden cardiac death
and cerebrovascular events.
3-6
In the presence of systolic and/or
diastolic dysfunction, many other cardiovascular events could
occur, such as arrhythmias and sudden cardiac death.
Several authors have demonstrated an increased cardiovascu-
lar risk associated with increased left ventricular mass (LVM).
7,8
The processes that ultimately lead to heart failure, among other
things, initially alter the left ventricular geometric pattern in
various ways. Left ventricular geometric pattern is therefore an
important prognostic factor in the epidemiology of cardiovascu-
lar diseases.
Blacks have been noted to have an increased prevalence of left
ventricular hypertrophy and increased associated cardiovascular
risk. The association of geometric patterns with left ventricular
systolic and diastolic function has not been well studied. The
development of heart failure in hypertensives with LVH results
from depressed left ventricular systolic function and/or diastolic
dysfunction. The deleterious effect of left ventricular remodel-
ling may be an important determinant of progression to overt
heart failure.
9
The aim of this study was to determine any possible asso-
ciation between left ventricular dysfunction and left ventricular
geometrical patterns in this population of treated Nigerian hyper-
tensives, using echocardiography.
Methods
This was a retrospective study among adult hypertensive subjects
(
≥
18 years) who had had complete echocardiographic examina-
tion as part of their work-up in a teaching hospital. Hypertension
was diagnosed with standard protocols when blood pressure
was
≥
140/90 mmHg on at least two occassions.
10
Only patients
receiving antihypertensive therapy were included. The following
information was obtained: gender, age at the time of the echocar-
diogram, weight, height, calculated body mass index (BMI), and
concurrent treatment with antihypertensive medication. BMI was
calculated as weight/height
2
(kg/m
2
).
In all patients, an abdominal ultrasound and urinalysis were
performed. Echocardiography was done in all patients to docu-
ment the presence or absence of LVH and also to document
the left ventricular geometrical pattern. These studies were
performed as part of the initial evaluation of hypertension or as
Division of Cardiology, Lautech Teaching Hospital, Osogbo,
Osun State, Nigeria
ADESEYE A AKINTUNDE, MD,
PATIENCE O AKINWUSI, MD
O GEORGE OPADIJO, MD
Division of Cardiology, Olabisi Onabanjo University
Teaching Hospital, Sagamu, Ogun State, Nigeria.
OLURANTI B FAMILONI, MD
Cardiology Clinic, Department of Internal Medicine III,
Eberhard Karls University, Tubingen, Germany
ADESEYE A AKINTUNDE, MD
