Table Of ContentLEFT VENTRICULAR HYPERTROPHY
WILLEM EINTHOVEN
1860-1927
Developments in
Cardiovascular Medicine
VOLUME 223
Left Ventricular Hypertrophy
Physiology versus Pathology
by
ERNST E. VAN DER WALL
ARNOUD VAN DER LAARSE
BABETTE M. PLUIM
and
ALBERT v.G. BRUSCHKE
Leiden University Medical Center,
Leiden, The Netherlands
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SPRINGER-SCIENCE+BUSINESS MEDIA, B.V.
A C.I. P. Catalogue record for this book is available from the Library of Congress
ISBN 978-94-010-5855-1 ISBN 978-94-011-4279-3 (eBook)
DOI 10.1007/978-94-011-4279-3
Printed an acid-free paper
AII Rights Reserved
© 1999 Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1999
Softcover reprint of the hardcover 1s t edition 1999
No part of the material protected by this copyright notice may be reproduced or
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TABLE OF CONTENTS
Foreword vii
List of Contributors IX
Chapter 1
Etiology of left ventricular hypertrophy
A. van der Laarse, C. Ruwhof, lE.T. van Wamel, E.E. van der Wall, A.V.G. Bruschke
Chapter 2
The role of vascular failure in heart failure 15
R.A. Tio, R. de Boer, D.J. van Veldhuisen, W.H. van Gilst
Chapter 3
Perfusion abnormalities in the hypertrophied left ventricle: Link. between compensated
hypertrophy and heart failure? 21
D.J.G.M. Duncker
Chapter 4
Assessment of left ventricular hypertrophy: a comparison of electrocardiography,
echocardiography and magnetic resonance imaging 43
A.I. Brees, B.M. Pluim, H.W. Vliegen, A. de Roos, H.J. Lamb, E.E. van der Wall
Chapter 5
Hypertrophy and hypertension 55
J.J. Schipperheijn
Chapter 6
Left ventricular hypertrophy: pathology versus physiology 65
B.M. Pluim, A. van der Laarse, H.W. Vliegen, A.V.G. Bruschke, E. E. van der Wall
vi
Chapter 7
The athlete's heart: a physiological or a pathological phenomenon? 85
B.M. Pluim, A. van der Laarse, E.E. van der Wall
Chapter 8
Left ventricular hypertrophic heart disease studied by MR imaging and 31p_MR
spectroscopy 107
R.J. Lamb, A. de Roos, E.E. van der Wall
Chapter 9
Hypertrophy and arrhythmias 121
A.A.M. Wilde
Chapter 10
Left ventricular hypertrophy: reversal by antihypertensive therapy 131
A. van der Laarse, E.E. van der Wall
Chapter 11
Postoperative regression of left ventricular hypertrophy 139
L.H.B. Baur, J. Braun, A.P. Kappetein, C.H. Peels, X.Y. Jin, Y. Houdas, E.A. van der
Velde, M. Hazekamp, E.E. van der Wall, A.V.G. Bruschke, H.A. Huysmans
Chapter 12
Myocardial hypertrophy and failure: a molecular approach 151
lM. van Dantzig, R. Bronsaer, P.A.F.M. Doevendans
Chapter 13
Hypertrophy: clinical relevance of genotype. Einthoven lecture 1999 163
K. Schwartz
Index 175
FOREWORD
The importance of left ventricular hypertrophy in cardiovascular disease has gained wide
recognition. Left ventricular hypertrophy is a highly important risk factor associated with
major cardiovascular events, including symptomatic heart failure, particularly in patients
with systemic hypertension. Over the past years much has been learned about the genetics,
molecular background, prevalence, incidence and prognosis of left ventricular hypertrophy.
A variety of noninvasive methods has emerged for detecting left ventricular hypertrophy
and the assessment of reversal of hypertrophy. Yet, a lot of controversy remains about the
connotations and clinical implications of left ventricular hypertrophy. For instance, in the
athlete's heart left ventricular hypertrophy may constitute a physiological adaptation to
pressure overload, which normalizes following discontinuation of strenuous physical
activity. On the other hand, in particular in patients with hypertension, left ventricular
hypertrophy denotes a serious prognosis in the course of hypertension. In these patients left
ventricular hypertrophy should be regarded as a grave prognostic sign rather than an
innocent compensatory phenomenon. The distinction between physiologic and
pathophysiologic left ventricular hypertrophy has been the basis for this book.
Basically, the interest for left ventricular hypertrophy in our institution (Leiden University
Medical Center) dates back to 1992 when we received a large investment grant from NWO
(Nederlands Wetenschappelijk Onderzoek, Dutch Scientific Investigation) to perform
magnetic resonance imaging and spectoscopy to evaluate individuals with left ventricular
hypertrophy. At that time, we decided to focus on three different groups of individuals with
left ventricular hypertrophy: elite athletes, patients with hypertension, and patients with
aortic valve disease. In this way approached, we tried to get an answer on the issue whether
one could distinguish between physiologic and pathologic left ventricular hypertrophy. This
was a large project involving both the Departments of Cardiology and Radiology of our
institution, and the full-time involvement of three research fellows. The project was also
supported by the Ministry of Welfare, Health and Culture (WVC), the Netherlands Heart
Foundation (NHS), and the Interuniversity Cardiology Institute of The Netherlands (ICIN),
the latter being an institute of the Royal Netherlands Academy of Arts and Sciences. The
project, as described in the grant, was almost completed in 1998 and at that time it was
decided that we would organize a special meeting around the topic left ventricular
hypertrophy.
Left ventricular hypertrophy -physiology versus pathology is a bibliographical reflection of
Vll
viii
a Boerhaave Symposium held on April 9, 1999, Leiden, The Netherlands. At this
symposium the major issues dealing with left ventricular hypertrophy were discussed from
etiology, genetics, detection, and therapy of left ventricular hypertrophy. In particular, the
book includes novel detection methods for left ventricular hypertrophy such as magnetic
resonance imaging and spectroscopy. Furthermore, much attention was paid to the
molecular and genetic approach of left ventricular hypertrophy. In the last chapter the
clinical relevance of genotype in the context of hypertrophy is described. This chapter was
composed by Prof.dr. K. Schwartz, who gave the illustrious Einthoven Lecture 1999 at the
end of the symposium. The Einthoven Lecture is named after Willem Einthoven, who was
awarded the Nobel Prize in 1924 for inventing the electrocardiogram. Every two years the
prestigious Einthoven Lecture is presented at our university by a well-known national or
international expert in the field of cardiovascular diseases.
The publication of the book would not have been possible without a generous educational
grant from Merck, Sharp and Dohme (Haarlem, The Netherlands). We like to acknowledge
the efforts of the authors, all of whom have written dedicated and well-focused chapters.
We also like to thank the Boerhaave Committee (Mrs. L. Zitter) who put a lot of effort in
preparation of the manuscript, and gave permission to publish this book. Lastly, we are
grateful for the support by Mrs. Amber Tanghe-Neely (Kluwer Academic Publishers,
Dordrecht) for proper guiding of the book preparation, and Mr. Jan Schoones (Leiden
Medical Library) who checked all the chapter references and took care of the Index.
We hope that our book will assist the clinical cardiologist, the fellows in cardiology, the
general internist, the radiologist, the cardiothoracic surgeon, the biochemist, the
physiologist, the pharmacologist, and the basic research fellow, in understanding the most
recent insights in the background of physiologic versus pathologic left ventricular
hypertrophy.
The Editors
Ernst E. van der Wall
Arnoud van der Laarse
Babette M. P1uim
Albert V.G. Bruschke
LIST OF CONTRIBUTORS
L.H.B. Baur
Department of Cardiology, Leiden University Medical Center
Albinusdreef2, P.O. Box 9600, 2300 RC Leiden, The Netherlands
Co-authors: A.V.G. Bruschke, 1. Braun, M. Hazekamp, Y. Houdas, H.A.Huysmans X.Y.
Jin, A.P. Kappetein, C.H. Peels, E.A. van der Velde, E.E. van der Wall
A.J. Brees
Department of Cardiology, Leiden University Medical Center
Albinusdreef2, P.O. Box 9600, 2300 RC Leiden, The Netherlands
Co-authors: B.M.Pluim, H. Lamb, A. de Roos, H.W. Vliegen, E.E. van der Wall
P.A.F.M. Doevendans
Department of Cardiology, Academic Hospital Maastricht
P. Debyelaan 25,6202 AZ Maastricht, The Netherlands
Co-authors: R. Bronsaer, J.M. van Dantzig
D.G.J.M. Duncker
Department of Experimental Cardiology, Erasmus University Rotterdam
P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
A. van der Laarse
Department of Cardiology, Leiden University Medical Center
Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands
Co-authors: A.V.G. Bruschke, C. Ruwhof, E.B. van der Wall, J.E.T. van Wamel
H. J. Lamb
Department of Radiology, Leiden University Medical Center
Albinusdreef2, P.O. Box 9600, 2300 RC Leiden, The Netherlands
Co-authors: A. de Roos, E.E. van der Wall
ix
x
B.M. Pluim
Royal Netherlands Lawn Tennis Association, Sports Medical Center Papendal,
Papendallaan 60,6816 VD Arnhem, The Netherlands
Co-authors: A.V.G. Bruschke, A. van der Laarse, H.W. Vliegen, E.E. van der Wall
J.J. Schipperheijn
Department of Cardiology, Leiden University Medical Center
Albinusdreef2, P.O. Box 9600, 2300 RC Leiden, The Netherlands
K. Schwartz, Directeur de Recherce lNSERMfCNRS
lNSERM, U 153,47, Boulevard de I'Hopital, 75651 Paris Cedex 13, France
R.A. Tio
Department of Clinical Pharmacology, University Groningen
Ant. Deusinglaan 1,9713 AV Groningen, The Netherlands
Co-authors: R. de Boer, W.H. van Gilst, DJ. van Veldhuisen
A.A.M. Wilde
Department of Cardiology, Amsterdam Medical Center
Meibergdreef9, 1105 AZ Amsterdam, The Netherlands
