background: Hypertensive cardiomyopathy (HT-CMP) is known as an important cause of reversible cardiomyopathy but its morphologic characteristics remain unclear. We aimed to investigate the difference of left atrial volume (LAV), left ventricular mass (LVM), and right ventricular function between recovered HT-CMP and idiopathic dilated cardiomyopathy (idDCMP).
Methods: We enrolled 18 hypertensive patients (mean age 63 ± 13 years, 56% women) admitted with severe left ventricular systolic dysfunction and heart failure. We compared clinical and echocardiographic parameters between the patients with HT-CMP and 18 age-matched patients with idDCMP. LVM and LAV were measured using echocardiography, and were indexed to body surface area. To detect the involvement of right ventricular (RV) dysfunction, RV size and RV hypokinesia were evaluated.
Results: In HT-CMP, LV ejection fraction (EF) improved from 28.8 ± 4.9 to 52.3 ± 8.8%, and LV end-diastolic dimension decreased from 64.1 ± 7.7 to 52.3 ± 6.5 mm during a mean follow-up of 574 days with medications. In HT-CMP, initial LAV index showed higher tendency as compared with idDCMP (31.9 ± 8.3 ml/m2 vs. 26.9 ± 9.0 ml/m2 respectively, p=0.09). At follow-up, LAV index decreased in HT-CMP (from 31.9 ± 8.3 ml/m2 to 21.0 ± 8.9 ml/m2, p<0.001), as opposed to a significant increase in idDCMP (from 26.9 ± 9.0 ml/m2 to 31.9 ± 8.3 ml/m2, p<0.001). There was no significant difference in initial LVM index between HT-CMP and idDCMP (192.2 ± 43.8 vs. 177.7 ± 47.6 g/m2), but only in HT-CMP, LVM index decreased significantly over time (151.5 ± 42.1 g/m2, p<0.01) at follow-up. In HT-CMP, LV wall on M-mode was thicker (septum, 10.8 ± 1.7 vs. 9.4 ± 1.8 mm; posterior wall, 10.9 ± 1.4 vs. 9.7 ± 1.9 mm, p<0.05) than in idDCMP. The incidence of RV hypokinesia was higher in idDCMP than in HT-CMP at initial examination (44 vs. 11%, p=0.02).
Conclusions: There was a tendency of higher LAV index in HT-CMP than in idDCMP at initial phase of heart failure. RV dysfunction was more frequent in idDCMP than in HT-CMP. LAV index and RV dysfunction might be helpful to discriminate HT-CMP from idDCMP at first admission with heart failure.
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