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Progression from normal to reduced left ventricular ejection fraction in patients with concentric left ventricular

Arun Krishnamoorthy1, Timothy Brown, Colby R Ayers

  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA.

The American Journal of Cardiology
|July 30, 2011
PubMed

Insights

Concentric left ventricular hypertrophy (LVH) infrequently leads to reduced ejection fraction (EF) long-term, especially without myocardial infarction. When reduced EF occurs, LV geometry typically remains concentric.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Clinical Medicine

Background:

  • Concentric left ventricular hypertrophy (LVH) is a common finding, but its progression to depressed left ventricular ejection fraction (LVEF) is not well understood.
  • Previous studies have not definitively established whether LVH is a direct precursor to reduced LVEF in humans.

Purpose of the Study:

  • To investigate the incidence and characteristics of LVEF decline in patients with pre-existing concentric LVH.
  • To determine the influence of myocardial infarction (MI) and follow-up duration on the development of depressed LVEF.

Main Methods:

  • Retrospective analysis of 555 patients with LVH and normal LVEF identified via echocardiography (1992-1994).
  • Follow-up LVEF assessment was available for 220 patients, categorized into short (≤7.5 years) and long (>7.5 years) term follow-up.
  • Primary outcome: development of qualitatively depressed LVEF. Subgroup analysis included presence or absence of interval MI.

Main Results:

  • After a median follow-up of 7.5 years, 20% of patients with concentric LVH developed a depressed LVEF.
  • The incidence of low LVEF was significantly higher in patients with interval MI (50% short-term, 44% long-term) compared to those without (13% short-term, 20% long-term).
  • Patients who developed reduced LVEF maintained a concentric LV geometry.

Conclusions:

  • The transition from concentric LVH to depressed LVEF is relatively infrequent (20%) over long-term follow-up, particularly in the absence of myocardial infarction.
  • Myocardial infarction is a significant risk factor for developing reduced LVEF in patients with concentric LVH.
  • LV geometry typically remains concentric even after the development of depressed LVEF in this cohort.

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