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Left ventricular mass and geometry and the risk of ischemic stroke
Marco R Di Tullio1, Donna R Zwas, Ralph L Sacco
1Department of Medicine,Sergievsky Center, Columbia-Presbyterian Medical Center, 630 W 168th St, New York, NY 10032, USA. md42@columbia.edu
Insights
Left ventricular hypertrophy (LVH) and abnormal LV geometry significantly increase ischemic stroke risk across diverse populations. Increased LV relative wall thickness independently predicts stroke, aiding risk assessment.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Left ventricular hypertrophy (LVH) is a known cardiovascular event risk factor.
- Its impact on ischemic stroke risk is primarily established in white populations.
- The specific role of left ventricular (LV) geometry in stroke risk remains underexplored.
Purpose of the Study:
- To investigate the independent association of LVH and LV geometric patterns with ischemic stroke risk.
- To evaluate these associations in a multiethnic population.
- To determine if LV geometry provides additional stroke risk prediction beyond LV mass.
Main Methods:
- A population-based case-control study involving 394 first ischemic stroke patients and 413 controls.
- Transthoracic echocardiography used to measure LV mass and identify LV geometric patterns (normal, concentric remodeling, concentric hypertrophy, eccentric hypertrophy).
- Conditional logistic regression analysis adjusted for stroke risk factors, stratified by age, sex, and race-ethnicity.
Main Results:
- Concentric hypertrophy showed the highest stroke risk (aOR, 3.5), followed by eccentric hypertrophy (aOR, 2.4).
- Concentric remodeling was associated with a slightly increased stroke risk (aOR, 1.7).
- Increased LV relative wall thickness independently predicted stroke risk (aOR, 1.6) after accounting for LV mass.
Conclusions:
- LVH and abnormal LV geometry are independently linked to elevated ischemic stroke risk.
- LVH demonstrates a strong association with stroke across all demographic subgroups.
- Increased LV relative wall thickness offers incremental value for stroke risk prediction, independent of LV mass.
Background And Purpose:
Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular events, but its effect on ischemic stroke risk is established mainly in whites. The effect of LV geometry on stroke risk has not been defined. The aim of the present study was to evaluate whether LVH and LV geometry are independently associated with increased ischemic stroke risk in a multiethnic population.
Methods:
A population-based case-control study was conducted on 394 patients with first ischemic stroke and 413 age-, sex-, and race-ethnicity-matched community control subjects. LV mass was measured by transthoracic echocardiography. LV geometric patterns (normal, concentric remodeling, concentric or eccentric hypertrophy) were identified. Stroke risk associated with LVH and different LV geometric patterns was assessed by conditional logistic regression analysis in the overall group and age, sex, and race-ethnic strata, with adjustment for established stroke risk factors.
Results:
Concentric hypertrophy carried the greatest stroke risk (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 2.0 to 6.2), followed by eccentric hypertrophy (adjusted OR, 2.4; 95% CI, 2.0 to 4.3). Concentric remodeling carried slightly increased stroke risk (adjusted OR, 1.7; 95% CI, 1.0 to 2.9). Increased LV relative wall thickness was independently associated with stroke after adjustment for LV mass (OR, 1.6; 95% CI, 1.1 to 2.3).
Conclusions:
LVH and abnormal LV geometry are independently associated with increased stroke risk. LVH is strongly associated with ischemic stroke in all age, sex, and race-ethnic subgroups. Increased LV relative wall thickness imparts an increased stroke risk after adjustment for LV mass and is of additional value in stroke risk prediction.