Left ventricular hypertrophy (PDF)

Author: Kluwer Academic Publishers Published year: 1999 Downloads: 9
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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 spectroscopy 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 of 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 of left ventricular hypertrophy.

Left ventricular hypertrophy - physiology versus pathology is a bibliographical reflection of 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 into the 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

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