Association between degree of left ventricular hypertrophy and severe coronary artery disease at autopsy of hypertensive individuals

Abstract

Background: It is believed that severe coronary artery disease (Severe CAD) is the major cause of death in hypertensive deceases presented with left ventricular hypertrophy (LVH). However, detailed autopsy studies on a series of hypertensive deceases that died suddenly have not been performed. Objective: This study aims to analyze the relationship between LVH and Severe CAD in autopsy findings of the Thai population. Material and Method: The research team identified 111 cases of Sudden Cardiac Death (SCD) with history of hypertension. Within these subjects, 83 cases had LVH and 66 cases had LVH with Severe CAD. The LV wall thickness and coronary artery disease (CAD) were evaluated and compared using Chi-square test (χ2). The correlation analysis was used to evaluate the interrelationship between Severe CAD (1, 2, 3-vessel disease) and LVH. Results: The result showed that 74.8% of the hypertensive cases had LVH and 59.5% had LVH with Severe CAD. There was an increased prevalence of Severe CAD coexisting with LVH deceases compared with Normal LV wall deceases group. The finding observed is statistically significant (p = 0.048). Deceased individuals with LVH Grade 1 and 1-vessel disease (19.7%) was the highest prevalence compared to other groups. Observing the total cases of all LVH grades combined, severe 1-vessel diseases was the prominent form of the disease (43.9%). In the aspect of all 1, 2, 3-vessel disease combined, it was observed that the highest prevalence of LVH cases was found in deceased individuals with LVH Grade 3 (36.4%). Considering the prevalence of 3-vessel disease, it was also significantly more frequent in LVH Grade 3 group compared to that of LVH Grade 2 and Grade 1 groups (16.7%, 7.6% and 1.5% respectively). Regarding the degree of LVH and its association with the presence of Severe CAD, it was observed that the greater the thickness of LV, the greater the proportion of cases with Severe CAD is found. This association between degree of LVH and Severe CAD (1, 2, 3-vessel disease) in positive correlation was statistically significant (p = 0.001). Conclusion: LVH may also be an important marker of CAD and reflects a prolonged exposure to hypertension. This requires a commitment to the early treatment of hypertension before hypertrophy develops. © 2018, Indian Journal of Forensic Medicine and Toxicology. All rights reserved.