HEART REMODELING PHENOTYPES BASED ON LEFT AND RIGHT VENTRICULAR CHANGES IN HYPERTENSION: PATHOLOGICAL AUTOPSY FINDINGS

Aiman Kerimkulova, Вебер Виктор Робертович, Lidiya Proshina, Akbayan Markabayeva, Riza Nurpeissova, Ainur Ospanova, Madina Adiyeva, Sultan Kuat

2025

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DOI 10.1097/01.hjh.0001116904.05016.50
Data confidence 70 medium
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Abstract

Objective: The aim of the study is to classify data on changes in the wall thickness of the left and right ventricles based on causes of death and to analyze their distribution among individuals suffering from hypertension, according to autopsy results. Design and method: A retrospective study was conducted based on the analysis of 614 autopsy reports of patients suffering from hypertension and died suddenly over a 16-year period. These patients had no other underlying conditions contributing to heart remodeling. Normal left ventricular wall thickness was considered to be 0.7–1.2 cm, and for the right ventricle, it was 0.2–0.3 cm. Left ventricular hypertrophy (LVH) was classified into Grade I (1.3–2.0 cm) and Grade II (equal to 2.1 cm), and right ventricular hypertrophy (RVH) into Grade I (0.4–0.6 cm) and Grade II (equal to 0.7 cm). Results: Changes in the right ventricle also play a substantial role, potentially influencing the prognosis of patients and requiring monitoring of right ventricular parameters. All autopsy data were categorized based on the changes observed in both the left and right ventricles. The mean age (Me, IQR; 25th to 75th centiles) was 56 (49–63) years. Based on the autopsy data, the following heart remodeling phenotypes were identified: 1) Type 1 – LVH without changes in the right ventricle (subgroups: LVH1, LVH2); 2) Type 2 – LVH1 with RVH (subgroups: LVH1+RVH1, LVH1+RVH2); 3) Type 3 – LVH2 with RVH (subgroups: LVH2+RVH1, LVH2+RVH2). Upon reviewing the data, the largest group (37.5%) was Type 3 (LVH2+RVH2), followed by Type 2 (23.9%), which involved both left and right ventricular thickening. Interestingly, Type 1 is much less frequent among hypertensive patients who died, especially those with isolated Grade II LVH (1.5%), indicating the presence of biventricular hypertrophy. Notably, there were frequent cases of more pronounced Grade II RVH with moderately expressed Grade I LVH (9.9%). Conclusions: A predominance of phenotypes with significant biventricular hypertrophy was found. The proposed classification (3 types, 6 subgroups) organizes heart changes in patients with hypertension and can be valuable for prognosis and the development of individualized treatment strategies.