LV Hypertrophy 4-Tier Outcomes in the General Population

Aug 19, 2015
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Authors:
Garg S, de Lemos JA, Ayers C, et al.
Citation:
Association of a 4-Tiered Classification of LV Hypertrophy With Adverse CV Outcomes in the General Population. JACC Cardiovasc Imaging 2015;Aug 19:[Epub ahead of print].
Summary By:
David S. Bach, MD, FACC

Study Questions:

Does a 4-tier classification on left ventricular hypertrophy (LVH) define risk of adverse cardiac outcomes in the general population?

Methods:

Participants from the Dallas Heart study who underwent cardiac magnetic resonance (CMR) and did not have LV dysfunction or a history of heart failure (HF; n = 2,458) were followed for a median of 9 years for the primary outcome of HF or cardiovascular (CV) death. A 4-tier classification for LVH was used, in which the presence of increased LV end-diastolic volume was used to subdivide eccentric LVH into “indeterminate hypertrophy” and “dilated hypertrophy,” and concentric LVH into “thick hypertrophy” and “both thick and dilated hypertrophy.” Multivariable Cox proportional hazard models were used to adjust for age, sex, African-American race, hypertension, diabetes, and history of CV disease.

Results:

In the cohort, 70% had no LVH, 404 (16%) had indeterminate hypertrophy, 30 (1%) had dilated hypertrophy, 289 (12%) had thick hypertrophy, and 7 (0.2%) had both thick and dilated hypertrophy. The cumulative incidence of HF or CV death was 2% with no LVH, 1.7% with indeterminate hypertrophy, 16.7% with dilated hypertrophy, 11.1% with thick hypertrophy, and 42.9% with both thick and dilated hypertrophy (log-rank p < 0.0001). Compared with participants without LVH, those with dilated (hazard ratio [HR], 7.3; 95% confidence interval [CI], 2.8-18.8), thick (HR, 2.4; 95% CI, 1.4-4.0), and both thick and dilated (HR, 5.8; 95% CI, 1.7-19.5) hypertrophy remained at increased risk for HF or CV death after multivariable adjustment, whereas the group with indeterminate hypertrophy was not (HR, 0.9; 95% CI, 0.4-2.2).

Conclusions:

In the general population, the 4-tiered classification system for LVH stratified LVH into subgroups with differential risk of adverse CV outcomes.

Perspective:

Using data from CMR, this large population-based cohort was divided into groups based on the absence of LVH (based on LV mass/height2.7), and subsets of both eccentric LVH and concentric LVH based on LV dilation (LV end-diastolic volume indexed to body surface area). The major study finding is that people with concentric LVH with or without LV dilation are at increased risk of heart failure or CV death, as are people with eccentric LVH and concomitant LV dilation; but that people with eccentric LVH without LV dilation (‘indeterminate LVH’) are not. This study and earlier studies found that people with ‘indeterminate LVH’ on CMR did not have reduced LV ejection fraction, elevated natriuretic peptides, or increased levels of cardiac troponin T; and other studies have demonstrated similar findings for ‘indeterminate LVH’ based on echocardiographic imaging. Together, these data suggest that ‘indeterminate LVH,’ often associated with obesity, appears to be a benign condition.

Keywords: Body Surface Area, Diagnostic Imaging, Heart Failure, Hypertrophy, Left Ventricular, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Natriuretic Peptides, Risk, Troponin T


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