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(Hypertension. 2004;43:714.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Concentric or Eccentric Hypertrophy: How Clinically Relevant Is the Difference?

From the Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy.

Correspondence to Dr Giovanni de Simone, Department of Clinical and Experimental Medicine, Federico II University Hospital, School of Medicine, v.S. Pansini 5-80131, Naples, Italy. E-mail simogi@unina.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Different combinations of volume and pressure overloads cause different left ventricular (LV) geometric adaptations. Whereas this cause-effect relationship is obvious for valve disease, because clear-cut types of overloads are easily recognizable, in systemic hypertension the type of cardiac load is less evident but at least as important for LV adaptation. Human arterial hypertension encompasses a large range of interactions between volume and pressure overloads, therefore producing a very large spectrum of possible LV adaptations. Based on the assumption that LV geometry is more useful than simple assessment of brachial blood pressure to identify the predominant type of overload, for convenience (and somewhat arbitrarily), we use generated cutoff points to define different LV geometric patterns according to the predominance of one hemodynamic load over the other one.¹

When considering together the prevalence of concentric remodeling and concentric LV hypertrophy,¹ we can easily conclude that pressure overload is the fundamental abnormality in arterial hypertension, although this is, in most circumstances, associated with some volume component. Thus, under chronic antihypertensive treatments that reduce pressure overload, a consistent reduction of concentric LV geometry can be expected when reduction of LV hypertrophy occurs.

Whether modifications of LV geometry from concentric to eccentric are beneficial beyond the reduction of LV mass has been debated; however, the conclusion has been, in general, that concentric LV hypertrophy is also characterized by greater LV mass than eccentric LV hypertrophy; therefore, these 2 features (ie, concentric geometry and LV hypertrophy) are so interrelated that they cannot to be easily discriminated.^2,3 . . . [Full Text of this Article]

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