head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue1
Subject Area: Medicine
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DOI: 10.5272/jimab.2026321.6708
Published online: 26 January 2026

Original article
J of IMAB. 2026 Jan-Mar;32(1):6708-6718
ARTERIAL HYPERTENSION: LEFT VENTRICULAR GEOMETRY AND DIASTOLIC DYSFUNCTION
Andrey IvanovORCID logo, Emil ManovORCID logo, Stefan NaydenovORCID logo, Nikolay RunevORCID logoCorresponding Autoremail,
Department of Internal Diseases "Prof. St. Kirkovich", Medical University of Sofia, Bulgaria.

ABSTRACT:
Echocardiography is an established method for assessing left ventricular structure and function in patients with arterial hypertension (AH).
Purpose. The study aims to investigate left ventricular geometry and diastolic dysfunction in patients with arterial hypertension and to assess gender-related differences in the established data.
Material/methods. A total of 278 individuals were studied, including 30 healthy controls (16 women and 14 men) and 248 patients with arterial hypertension (139 women and 109 men). The echocardiographic examination included M-Mode and B-Mode echocardiography, pulsed-wave spectral Doppler, and pulsed-wave tissue Doppler imaging.
Results. Using the criteria of left ventricular mass index (LVMI) > 115 g/m2 in men and LVMI > 95 g/m2 in women for defining left ventricular hypertrophy (LVH), we found LVH in 147 of the hypertensive patients (59.27%). In our patients, LVH was more common in women. LVH was found in 97 women (69.78% of the women with AH) and 50 men (45.87% of the men with AH). One hundred and six (106) patients (42.74%) had no diastolic dysfunction. Grade 1 diastolic dysfunction was found in 95 patients (38.31%), grade 2 in 43 patients (17.34%), and grade 3 in 4 patients (1.61%).
Conclusion. In the studied patients with arterial hypertension, a number of echocardiographic indices were found which differed significantly from those in the individuals from the control group. Regular echocardiographic assessment is essential for guiding therapy and reducing the risk in these patients.

Keywords: left ventricular mass, left ventricular hypertrophy, diastolic dysfunction,

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Please cite this article as: Ivanov A, Manov E, Naydenov S, Runev N. Arterial Hypertension: Left Ventricular Geometry and Diastolic Dysfunction. J of IMAB. 2026 Jan-Mar;32(1):6708-6718. [Crossref - 10.5272/jimab.2026321.6703]

Corresponding AutorCorrespondence to: Prof. Nikolay Runev, MD, PhD, Department of Internal Diseases "Prof. St. Kirkovich", Medical University of Sofia; 1, St. Georgi Sofiiski Str., Sofia, Bulgaria; E-mail: nrunev@abv.bg

REFERENCES:
1. Manov E, Shabani R, Naydenov SN, Runev NM, Donova TI. Effects of aliskiren on blood pressure and myocardial function assessed by global longitudinal strain in patients with arterial hypertension and diastolic dysfunction. Folia Med (Plovdiv) 2012;54(3):30-4 [PubMed]
2. Vitlyanova K, Naidenov S, Runev N et al. Effects of the angiotensin receptor blocker Valsartan (Valsacor(R)) on arterial pressure, indices of myocardial diastolic function and global longitudinal strain in patients with uncontrolled arterial hypertension. Vnitr Lek 2013;59(12):1124-8 [PubMed]
3. Zanchetti A, Cuspidi C, Comarella L et al. Left ventricular diastolic dysfunction in elderly hypertensives: results of the APROS-diadys study. J Hypertens 2007;25(10):2158-67 [PubMed]
4. Adebayo RA, Bamikole OJ, Balogun MO et al. Echocardiographic assessment of left ventricular geometric patterns in hypertensive patients in Nigeria. Clin Med Insights Cardiol 2013;7:161-7 [PubMed]
5. De-la-Garza-Salazar F. Diagnostic utility of 31 ECG criteria for predicting echocardiographic left ventricular geometry. Arch Cardiol Mex 2022;92(4):492-501 [PubMed]
6. Xu M, Ge Z, Huang J et al. Modified Cornell electrocardiographic criteria in the assessment of left ventricular hypertrophy geometry of patients with essential hypertension. J Clin Hypertens (Greenwich) 2020;22(7):1239-1246 [PubMed]
7. Ballo P, Nistri S, Cameli M et al. Association of left ventricular longitudinal and circumferential systolic dysfunction with diastolic function in hypertension: a nonlinear analysis focused on the interplay with left ventricular geometry. J Card Fail 2014;20(2):110-20 [PubMed]
8. Huang H, Fu L, Ruan Q, You Z, Yan L. Segmental and global myocardial work in hypertensive patients with different left ventricular geometry. Cardiovasc Ultrasound 2023;21(1):11 [PubMed]
9. Marchev ST. Assessment of longitudinal left ventricular function in hypertensive disease with tissue Doppler echocardiography. Dissertation. 2012 [Internet]
10. Eguchi K, Kario K, Hoshide S, Ishikawa J, Morinari M, Shimada K. Type 2 diabetes is associated with left ventricular concentric remodeling in hypertensive patients. Am J Hypertens 2005;18(1):23-9 [PubMed]
11. Wachtell K, Smith G, Gerdts E et al. Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy (the LIFE study). Losartan Intervention For Endpoint. Am J Cardiol 2000;85(4):466-72 [PubMed]
12. Nadruz W, Shah AM, Solomon SD. Diastolic Dysfunction and Hypertension. Med Clin North Am 2017;101(1):7-17 [PubMed]
13. Reichek N. Standardization in the measurement of left ventricular wall mass. M-mode echocardiography. Hypertension 1987;9(2 Pt 2):II27-9 [PubMed]
14. Foppa M, Duncan BB, Rohde LE. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound 2005;3:17 [PubMed]
15. Devereux RB. Detection of left ventricular hypertrophy by M-mode echocardiography. Anatomic validation, standardization, and comparison to other methods. Hypertension 1987;9(2 Pt 2):II19-26 [PubMed]
16. Ji D, Zhang B, He B. The Diagnostic Value of the Deepest S Wave in 12-Lead Electrocardiogram to Elderly Patients with Essential Hypertension and Left Ventricular Hypertrophy. Clin Interv Aging 2022;17:1663-1672 [PubMed]
17. Marwick TH, Gillebert TC, Aurigemma G et al. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr 2015;28(7):727-54 [PubMed]
18. Ivanov A, Levunlieva E. Echocardiographic estimation of left ventricular filling pressure. Bul J Cardiol. 2014; 3(2):48-64 [Internet]
19. Nagueh SF, Smiseth OA, Appleton CP et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016;29(4):277-314 [PubMed]
20. AlMarri EA, Al-Hamad J. Prevalence of obesity among hypertensive patients in Primary Care Clinic, Security Forces Hospital, Riyadh, Saudi Arabia 2017-2018: A prospective cross-sectional study. J Family Med Prim Care 2020;9(4):1885-1890 [PubMed]
21. Noor SK, Fadlelseed MHE, Bushara SO et al. Prevalence of obesity related hypertension among overweight or obese adults in River Nile State in Northern Sudan: a community based cross-sectional study. Cardiovasc Diagn Ther. 2023;13(2):384-394 [PubMed]
22. Tu J, Chen H, Zeng Q, Chen L, Guo Y, Chen K. Trends in Obesity Prevalence Among Adults With Hypertension in the United States, 2001 to 2023. Hypertension 2025;82(3):498-508 [PubMed]
23. Zhang Y, Hou L-S, Tang W-W, et al. High prevalence of obesity-related hypertension among adults aged 40 to 79 years in Southwest China. Scientific Reports 2019;9(1):15838  [PubMed]
24. Shariq OA, McKenzie TJ. Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surg 2020;9(1):80-93 [PubMed]
25. Woodiwiss AJ, Libhaber CD, Majane OH, Libhaber E, Maseko M, Norton GR. Obesity promotes left ventricular concentric rather than eccentric geometric remodeling and hypertrophy independent of blood pressure. Am J Hypertens 2008;21(10):1144-51 [PubMed]
26. Cuspidi C, Rescaldani M, Sala C, Grassi G. Left-ventricular hypertrophy and obesity: a systematic review and meta-analysis of echocardiographic studies. J Hypertens 2014;32(1):16-25 [PubMed]
27. Russo C, Jin Z, Homma S et al. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am Coll Cardiol 2011;57(12):1368-74 [PubMed]
28. Kanter R, Caballero B. Global gender disparities in obesity: a review. Adv Nutr 2012;3(4):491-8 [PubMed]
29. Cooper AJ, Gupta SR, Moustafa AF, Chao AM. Sex/Gender Differences in Obesity Prevalence, Comorbidities, and Treatment. Curr Obes Rep 2021;10(4):458-466 [PubMed]
30. Bombelli M, Vanoli J, Cuspidi C et al. Comparison of electrocardiographic versus echocardiographic detection of left ventricular mass changes over time and evaluation of new onset left ventricular hypertrophy. J Clin Hypertens (Greenwich). 2023;25(4):343-349 [PubMed]
31. Truszkiewicz K, Macek P, Poreba M, Poreba R, Gac P. Radiological Cardiothoracic Ratio as a Potential Marker of Left Ventricular Hypertrophy Assessed by Echocardiography. Radiol Res Pract. 2022;2022:4931945 [PubMed]
32. Domienik-Karlowicz J, Rymarczyk Z, Lisik W et al. Questionable validity of left ventricular hypertrophy cutoff values in morbidly and super-morbidly obese patients. Ann Noninvasive Electrocardiol. 2018;23(6):e12564 [PubMed]
33. Chahal NS, Lim TK, Jain P, Chambers JC, Kooner JS, Senior R. New insights into the relationship of left ventricular geometry and left ventricular mass with cardiac function: A population study of hypertensive subjects. Eur Heart J. 2010;31(5):588-94 [PubMed]
34. Ruilope LM, Schmieder RE. Left ventricular hypertrophy and clinical outcomes in hypertensive patients. Am J Hypertens. 2008;21(5):500-8 [PubMed]
35. Casiglia E, Schiavon L, Tikhonoff V et al. Electrocardiographic criteria of left ventricular hypertrophy in general population. Eur J Epidemiol. 2008;23(4):261-71 [PubMed]
36. Iyengar SS, Ram CVS. Concentric vs. Eccentric Left Ventricular Hypertrophy: Does It Matter? It Is All "Blood Pressure Centered". Am J Hypertens. 2021;34(6):581-582 [PubMed]
37. Aronow WS. Hypertension and left ventricular hypertrophy. Ann Transl Med. 2017;5(15):310 [PubMed]
38. Santos AB, Gupta DK, Bello NA, et al. Prehypertension is Associated With Abnormalities of Cardiac Structure and Function in the Atherosclerosis Risk in Communities Study. Am J Hypertens. 2016;29(5):568-74 [PubMed]
39. Tadic M, Cuspidi C, Saeed S, et al. The influence of left ventricular geometry on myocardial work in essential hypertension. J Hum Hypertens. 2022;36(6):524-530 [PubMed]
40. Phanzu BK, Natuhoyila AN, Vita EK, Longo-Mbenza B, Kabangu JM. Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study. Cardiovasc J Afr. 2023;34:1-8 [PubMed]
41..Voors AA, Terpstra WF, Smit AJ et al. Gender-related differences in left ventricular structural and functional responses to hypertension. J Hum Hypertens. 2005;19(11):915-7 [PubMed]
42..Appolinaire KB, Michel KB, Hermann Y, et al. [Left ventricular geometry study in black African hypertensives]. Ann Cardiol Angeiol (Paris). 2023;72(2):101583 [PubMed]  
43..Dini FL, Galderisi M, Nistri S, et al. Abnormal left ventricular longitudinal function assessed by echocardiographic and tissue Doppler imaging is a powerful predictor of diastolic dysfunction in hypertensive patients: the SPHERE study. Int J Cardiol. 2013;168(4):3351-8 [PubMed]
44. Paudel S, Gautam MP, Baral YN, et al. Prevalence of Left Ventricular Diastolic Dysfunction in Patients with Essential Hypertension. J Nepal Health Res Counc. 2023;20(3):659-663 [PubMed]
45. Jaroch J, Loboz Grudzien K, Bociaga Z, et al. The relationship of carotid arterial stiffness to left ventricular diastolic dysfunction in untreated hypertension. Kardiol Pol. 2012;70(3):223-31 [PubMed]
46. Sciarretta S, Paneni F, Ciavarella GM et al. Evaluation of systolic properties in hypertensive patients with different degrees of diastolic dysfunction and normal ejection fraction. Am J Hypertens. 2009;22(4):437-43 [PubMed]
47. Mottram PM, Haluska BA, Leano R, Carlier S, Case C, Marwick TH. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart. 2005;91(12):1551-6 [PubMed]
48. Abubakar IG, Buba F, Oyati AI, Talle MA, Anjorin CO. Prevalence of Doppler-Derived Left Ventricular Diastolic Dysfunction Among Newly Diagnosed Hypertensive Patients. Niger J Clin Pract. 2023;26(11):1630-1636 [PubMed]

Received: 14 August 2025
Published online: 26 January 2026

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