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Left ventricular hypertrophy patterns and incidence of heart failure with preserved versus reduced ejection fraction

Raghava S Velagaleti1, Philimon Gona2, Michael J Pencina3

  • 1Framingham Heart Study, Framingham, Massachusetts; Division of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts.

The American Journal of Cardiology
|November 12, 2013
PubMed

Insights

Different left ventricular (LV) hypertrophy patterns increase heart failure (HF) risk. Eccentric hypertrophy is linked to HF with reduced ejection fraction, while concentric hypertrophy is associated with HF with preserved ejection fraction.

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Left ventricular (LV) mass, wall thickness, and internal dimension are established risk factors for heart failure (HF).
  • The specific impact of distinct LV hypertrophy patterns on the incidence and types of HF remains incompletely understood.

Purpose of the Study:

  • To investigate the association between different patterns of LV hypertrophy and the incidence of new-onset HF.
  • To determine if specific LV hypertrophy patterns are differentially related to HF with reduced ejection fraction (HFrEF) versus HF with preserved ejection fraction (HFpEF).

Main Methods:

  • Classified 4,768 Framingham Heart Study participants into four LV hypertrophy groups: normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy.
  • Utilized American Society of Echocardiography criteria for LV mass indexed to body surface area and relative wall thickness.
  • Followed participants for a mean of 21 years to ascertain HF incidence and type.

Main Results:

  • LV hypertrophy patterns were significantly associated with increased HF incidence compared to normal LV morphology (p = 0.0002).
  • Eccentric hypertrophy demonstrated the highest HF risk (HR 1.89), followed by concentric hypertrophy (HR 1.40).
  • Eccentric hypertrophy was linked to a higher risk of HFrEF (HR 2.23), whereas concentric hypertrophy was associated with an increased risk of HFpEF (HR 1.66).

Conclusions:

  • In a large community-based cohort, distinct LV hypertrophy patterns differentially influence HF risk and type.
  • Eccentric hypertrophy is a significant predictor of HFrEF.
  • Concentric hypertrophy is a notable risk factor for HFpEF.

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