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Prediction of mortality in patients with left ventricular hypertrophy by clinical, exercise stress, and
Abdou Elhendy1, Karen M Modesto, Douglas W Mahoney
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Insights
Left ventricular hypertrophy (LVH) increases cardiovascular risk. Exercise echocardiography identifies mortality predictors like LV mass index and ejection fraction response, guiding risk stratification for patients with LVH.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Exercise Physiology
Background:
- Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular morbidity and mortality.
- Understanding predictors of adverse outcomes in LVH is crucial for patient management.
Purpose of the Study:
- To evaluate clinical, exercise stress test, and echocardiographic predictors of mortality and cardiac events in patients with LVH.
- To identify key indicators for risk stratification in this patient population.
Main Methods:
- Symptom-limited treadmill exercise echocardiography was performed in 483 patients with LVH.
- Follow-up endpoints included all-cause mortality and hard cardiac events (cardiac death, nonfatal myocardial infarction).
- Multivariate analysis assessed predictors including workload, rate pressure product, LV mass index, and ejection fraction response.
Main Results:
- Abnormal exercise echocardiography was associated with significantly higher cumulative mortality rates over five years.
- Independent predictors of mortality included lower workload, lower rate pressure product, higher LV mass index, and failure to increase ejection fraction with exercise.
- Predictors of cardiac events included prior coronary artery bypass grafting, lower exercise rate-pressure product, resting wall motion score index, and impaired ejection fraction response.
Conclusions:
- Left ventricular mass index and ejection fraction response to exercise are independent predictors of mortality in LVH patients.
- These echocardiographic findings provide incremental prognostic information beyond clinical and exercise test data.
- A normal exercise echocardiogram indicates a relatively low mortality risk within three years.
Objectives:
This study evaluated the clinical, exercise stress test, and echocardiographic predictors of mortality and cardiac events in patients with left ventricular hypertrophy (LVH).
Background:
Left ventricular hypertrophy is associated with an increased risk of cardiovascular morbidity and mortality.
Methods:
Symptom-limited treadmill exercise echocardiography was performed for evaluation of coronary artery disease in 483 patients (age, 66 +/- 11 years; 281 men) with LVH. End points during follow-up were all-cause mortality and hard cardiac events (cardiac death and nonfatal myocardial infarction [MI]).
Results:
Forty-six patients died and 14 had nonfatal MI. The cumulative mortality rate was higher in patients with abnormal exercise echocardiography (3% vs. 0.4% at one year, 11.7% vs. 3.7% at three years, and 18.3% vs. 9.5% at five years, p < 0.001). In a sequential multivariate analysis model of clinical, exercise test, and rest and exercise echocardiographic data, incremental predictors of mortality were workload (hazard ratio [HR], 0.5; 95% confidence interval [CI], 0.3 to 0.9), rate pressure product (HR, 0.7; 95% CI, 0.5 to 0.9), left ventricular (LV) mass index (HR, 1.4; 95% CI, 1.1 to 1.8), and failure to increase ejection fraction (EF) with exercise (HR, 2.1; 95% CI, 1.1 to 3.8). Predictors of cardiac events were history of coronary artery bypass grafting (HR, 2.6; 95% CI, 1.2 to 5.4), lower exercise rate-pressure product (HR, 0.6; 95% CI, 0.5 to 0.8), resting wall motion score index (HR, 1.4; 95% CI, 1.1 to 1.8), and failure to increase EF with exercise (HR, 3.3; 95% CI, 1.6 to 6.9).
Conclusions:
In patients with LVH, LV mass index and EF response to exercise are independent predictors of mortality, incremental to clinical and exercise test data and resting LV function. A normal exercise echocardiogram predicts a relatively low mortality rate during the following three years.
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01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes