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Four-group classification of left ventricular hypertrophy based on ventricular concentricity and dilatation
Casper N Bang1, Eva Gerdts2, Gerard P Aurigemma2
1From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.). casperbang@hotmail.com.
Insights
A new classification of left ventricular hypertrophy (LVH) in hypertensive patients identifies specific types, like eccentric dilated and concentric dilated LVH, as high-risk for adverse cardiovascular events and mortality.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Hypertension Research
Background:
- Traditional classification of left ventricular hypertrophy (LVH) relies on relative wall thickness.
- A new 4-group classification incorporates LV dilatation and concentricity for hypertensive patients.
- This study evaluates the prognostic value of this new LVH classification.
Purpose of the Study:
- To assess the predictive value of a novel 4-group LVH classification for adverse cardiovascular events.
- To compare the risks associated with different LVH subtypes and normal LV mass.
- To analyze the impact of treatment on LVH prevalence and associated risks.
Main Methods:
- Utilized data from the Losartan Intervention for Endpoint Reduction (LIFE) echocardiography substudy.
- Classified 939 hypertensive patients into 4 LVH groups (concentric nondilated, eccentric dilated, concentric dilated, eccentric nondilated) and a normal LV mass group.
- Employed time-varying multivariable Cox analyses to associate LVH classes with mortality and composite endpoints.
Main Results:
- At baseline, LVH subtypes varied in prevalence: eccentric nondilated (12%), eccentric dilated (20%), concentric nondilated (29%), and concentric dilated (14%).
- Treatment led to a significant shift in LVH prevalence, with 62% having normal LV mass after 4 years.
- Eccentric dilated, concentric nondilated, and concentric dilated LVH were associated with increased risks of mortality and composite cardiovascular events compared to normal LV mass.
Conclusions:
- Hypertensive patients with eccentric dilated, concentric nondilated, and concentric dilated LVH face elevated risks of adverse cardiovascular outcomes.
- The eccentric nondilated LVH group did not show increased risk, similar to patients with normal LV mass.
- This new classification provides a more refined risk stratification for hypertensive individuals with LVH.
Background:
Left ventricular hypertrophy (LVH; high LV mass [LVM]) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of subsequent adverse events in a new 4-group LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV](2/3)) in hypertensive patients.
Methods And Results:
In the Losartan Intervention for Endpoint Reduction (LIFE) echocardiography substudy, 939 hypertensive patients with measurable LVM at baseline were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. Patients with LVH (LVM/body surface area ≥116 and ≥96 g/m(2) in men and woman, respectively) were divided into 4 groups-concentric nondilated (increased M/EDV, normal EDV), eccentric dilated (increased EDV, normal M/EDV), concentric dilated (increased M/EDV and EDV), and eccentric nondilated (normal M/EDV and EDV)-and compared with patients with normal LVM. Time-varying LVH classes were tested for association with all-cause and cardiovascular mortality and a composite end point of myocardial infarction, stroke, heart failure, and cardiovascular death in multivariable Cox analyses. At baseline, the LVs were categorized as eccentric nondilated in 12%, eccentric dilated in 20%, concentric nondilated in 29%, concentric dilated in 14%, and normal LVM in 25%. Treatment changed the prevalence of 4 LVH groups to 23%, 4%, 5%, and 7%; 62% had normal LVM after 4 years. In time-varying Cox analyses, compared with normal LVM, those with eccentric dilated and both concentric nondilated and dilated LVH had increased risks of all-cause or cardiovascular mortality or the composite end point, whereas the eccentric nondilated group did not.
Conclusions:
Hypertensive patients with relatively mild LVH without either increased LV volume or concentricity have similar risk of all-cause mortality or cardiovascular events because hypertensive patients with normal LVM seem to be a low-risk group.
Clinical Trial Registration Url:
http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
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