ABC | Volume 114, Nº1, January 2019

Original Article Almeida et al. Left ventricular remodeling in primary care Arq Bras Cardiol. 2020; 114(1):59-65 Figure 1 – A, B, and C: Evaluation of parameters of renal function in different patterns of left ventricular remodeling. 2.2% 1.7% 24.2% 71.9% 53.2% 38.7% 4.8% 3.2% 65.2% 32.6% 1.5% 0.7% Normal renal function Albuminuria + GFR > 60 mL/min GFR = 15-59 mL/min Normal geometry Eccentric hipertrophy Concentric hipertrophy Concentric remodelling A C B Ventricular remodeling throughout life occurs as an adaptive response to aging, exposure to risk factors for cardiovascular disease and myocardial injury. 11 A study carried out in the community with 4492 participants (mean age 51 years and 59%women) showed that 64% had normal geometry, 18% had concentric remodeling, 13% had eccentric hypertrophy, and 5% had concentric hypertrophy. Our data are similar to the population with normal geometry (64 vs. 67%), but different in relation to remodeling standards, especially regarding concentric remodeling (18% vs. 2%) and eccentric hypertrophy (13% vs. 29%). These differences can also be explained by the greater number of hypertensive and diabetic patients observed in our study in relation to the trial of Lieb et al. 11 A study conducted in the community by Teh et al. 12 assessed the prevalence of the four remodeling models in 108 patients aged >70 years, in which 56% were women, 84% had hypertension, and 20% had diabetes. 12 Although the data of Teh et al. 12 were obtained in an older population, they are similar to ours in relation to the higher prevalence of eccentric hypertrophy observed in the sample (26% vs 29%), showing that there seems to be an increased prevalence of eccentric remodeling in older individuals and those with more comorbidities. Aging is directly related to the progression of cardiac remodeling, most likely due to exposure to multiple cardiovascular risk factors. This finding was present in our study as well as in the literature. 13 We observed an association between female gender and the presence of LV eccentric hypertrophy after adjusting for other variables (OR, 95%CI, 1.75 [1.17 to 2.61]). There are differences in cardiac structure and function in relation to gender, and these differences appear to be more pronounced in the presence of risk factors for HF with preserved ejection fraction (HFpEF), and they can be explained by sexual dimorphism. 14 A study evaluating changes in LV stiffness in 1,402 individuals in the community observed an increase in stiffness with aging, which is increased in women more frequently than in men. 15 A study involving 318 healthy adults from the FraminghamHeart Study who underwent MRI to determine the reference values of LV parameters observed a greater increase in the linear dimensions of the LV after adjustment for body surface area in women than in men (p < 0.001). 16 Our data showed that low educational level had an association with eccentric hypertrophy. Such a result can be explained by greater exposure to risk factors, less understanding about self-care, and less adherence to drug treatment. Microalbuminuria is an important cardiovascular risk marker, 17 and the data presented here showed that individuals with changes in ventricular geometry had high levels of urinary albumin and worsening renal function assessed by GFR. Individuals with impaired renal function have a progressive increase in eccentric hypertrophy, which may reflect heart diseasewith concomitant loss of kidney function. Both concentric and eccentric patterns reflect hypertensive nephropathy, which progresses with structural heart disease. Studies show the existence of an association between albuminuria, remodeling, and cardiovascular disease. Increased urinary albumin excretion is associated with changes in ventricular remodeling in patients with hypertension. Patients with hypertension who have albuminuria regression disability have a higher incidence of cardiovascular disease. 18 Our data show there is a strong association between the albumin/creatinine ratio and the development of eccentric LV hypertrophy. This study was the first in the Brazilian primary care population to specifically study the LV geometry with inclusion of RWT. The greater inclusion of female patients is noteworthy as a limitation to the study. This was due to greater adherence of women to the study protocol. Similarly, the greater adherence 63