on June 12, 2003
Published online before print June 12, 2003, doi: 10.1161/01.STR.0000078310.98444.1D
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Submitted on February 6, 2003
From the Departments of Angio-Cardio-Neurology (G.S., A.N., A.M., V.S., G.F., B.T., G.L.) and of Neuro-Radiology (V.C., C.C.), IRCCS Neuromed, Pozzilli (IS), and the Neuro-Radiology Section (C.C.) and Department of Experimental Medicine and Pathology (G.L.), Università La Sapienza, Rome, Italy. * To whom correspondence should be addressed. E-mail: lembo{at}neuromed.it.
Background and Purpose--It has been demonstrated that left ventricular hypertrophy (LVH) confers an increased risk for major cerebrovascular events. However, it is still uncertain whether there is an association between LVH and asymptomatic cerebrovascular damage in hypertensive patients. In this study, we investigated the relation between LVH, evaluated by both echocardiography (Echo-LVH) and electrocardiography (ECG-LVH), and preclinical cerebral damage, as identified by magnetic resonance imaging. Methods--One hundred ninety-five consecutive patients were enrolled in the study. We evaluated other risk factors such as age, sex, presence of diabetes, cholesterol levels, smoking status, heart rate, and systolic and diastolic blood pressure. Asymptomatic cerebrovascular damage was considered silent cerebral lesions: punctate lesions, lacunes, and territorial lesions. Patients were divided into 2 groups according to the presence of asymptomatic brain lesions. Results--The 2 groups of patients differed only in terms of age and systolic pressure. More importantly, the prevalence of Echo-LVH (83% versus 47.7%, P<0.001) and ECG-LVH (56% versus 22%, P<0.001) was significantly higher in patients with asymptomatic brain lesions. A multivariate analysis allowed us to recognize LVH as the only independent predictor for the presence of ischemic lacunes (P<0.001). Moreover, we evaluated the impact of left ventricular geometry on asymptomatic cerebrovascular damage, and we found that hypertensives with concentric hypertrophy displayed more pronounced asymptomatic cerebrovascular damage compared with patients with eccentric hypertrophy. Conclusions--Our study demonstrates that LVH is associated with cerebral damage even in the absence of clinical symptoms. Thus, the presence of cardiac damage provides important prognostic clues about the presence of asymptomatic cerebral damage.
Accepted on February 24, 2003
Left Ventricular Hypertrophy Is Associated With Asymptomatic Cerebral Damage in Hypertensive Patients
Giulio Selvetella MD;
Key words: cerebral infarction • electrocardiography • hypertension • magnetic resonance imaging • risk factors
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