A Novel Index of Remodeling in Hypertensive Heart Disease

Left ventricular hypertrophy (LVH) is thought to be an adaptive response that allows for normal ejection fraction despite abnormal pressure or volume load, or a combined pressure and volume load.1 However, this adaptation is associated with substantially increased morbidity and mortality.2 Echocardiography helped create the dossier on the prevalence and consequences of LVH in hypertension and outcome response to treatment.3,4 Echocardiography and now cardiac magnetic resonance imaging (CMR), a more precise means to measure have been used in cross-sectional and epidemiological studies and serially in clinical trials.4,5See Article by Goh et al LVH, which is most properly defined as an increase in left ventricular (LV) mass in relation to body size (ie, high LV mass index),4,6 is produced either by an abnormal increase in chamber size, an abnormal increase in wall thickness, or abnormal increases in both. In general, in higher than expected LV wall thickness is associated with a normal end-diastolic volume.7 For decades, concentric hypertrophy—an abnormally high LV wall mass and an abnormally high ratio of LV wall thickness/the size of the LV cavity—was thought to be the most common response pattern to chronic pressure overload.A major conceptual advance in our thinking about the LV response to pressure overload occurred a quarter-century ago when the Cornell group published a simple quantitative classification paradigm based on standard linear echocardiographic data in a study of untreated hypertensive patients.8 They categorized the LV response to hypertension based on partition values for (1) the LV mass indexed to body surface area and (2) the ratio of LV wall thickness/LV chamber size—the geometry of the LV, or the relative wall thickness (RWT). In this scheme, there were 4 possible geometry/hypertrophy combinations: normal LV mass index and …