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Progression from concentric left ventricular hypertrophy and normal ejection fraction to left ventricular dysfunction

Richard V Milani1, Mark H Drazner, Carl J Lavie

  • 1Department of Cardiology, Ochsner Clinic Foundation, University of Queensland Ochsner Clinical School, New Orleans, Louisiana, USA. rmilani@ochsner.org

The American Journal of Cardiology
|July 26, 2011
PubMed

Insights

Thirteen percent of patients with concentric left ventricular (LV) hypertrophy and normal ejection fraction developed systolic dysfunction over 3 years. Key risk factors included myocardial infarction, prolonged QRS duration, and elevated arterial impedance.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Clinical Research

Background:

  • Concentric left ventricular (LV) hypertrophy, caused by increased LV afterload, is linked to cardiovascular events.
  • While LV hypertrophy can lead to heart failure, data on progression to systolic dysfunction in patients with initially normal ejection fraction are limited.

Purpose of the Study:

  • To determine the frequency of deterioration to systolic dysfunction in patients with concentric LV hypertrophy and normal ejection fraction.
  • To identify risk factors associated with the development of LV systolic dysfunction in this patient cohort.

Main Methods:

  • Evaluation of baseline and follow-up data from 1,024 patients with concentric LV hypertrophy and normal ejection fraction.
  • Paired echocardiograms obtained at least 1 year apart were analyzed.
  • Risk factors including interval myocardial infarction, QRS duration, and arterial impedance were assessed.

Main Results:

  • Systolic dysfunction developed in 13% of patients (134/1024) after a mean follow-up of 33 months.
  • Interval myocardial infarction was the most common associated variable (43%).
  • Prolonged QRS duration (>120 ms) and elevated arterial impedance (>4.0 mm Hg/ml/m²) significantly increased the risk of developing LV systolic dysfunction, with a fourfold increased risk if both were present.

Conclusions:

  • Approximately 13% of patients with normal ejection fraction and concentric LV hypertrophy progress to systolic dysfunction within 3 years.
  • Interval myocardial infarction, prolonged QRS duration, and elevated arterial impedance are significant risk factors for this functional decline.
  • Standard blood pressure measurements may not fully capture elevated arterial impedance.

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