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"Malignant" Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left
Matthew N Peters1, Stephen L Seliger2, Robert H Christenson3
1Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD.
Insights
Malignant left ventricular hypertrophy (LVH) with elevated cardiac biomarkers predicts heart failure (HF) and cardiovascular death in adults without prior cardiovascular disease. This high-risk phenotype warrants targeted surveillance and aggressive treatment strategies for prevention.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarker Research
Background:
- Heart failure (HF) morbidity and mortality are increasing, necessitating enhanced prevention strategies.
- Malignant left ventricular hypertrophy (LVH), defined by LVH plus elevated cardiac biomarkers (troponin T or NT-proBNP), predicts accelerated HF progression.
- The study investigates whether malignant LVH identifies asymptomatic adults at high risk for decline in LV ejection fraction or cardiovascular events.
Purpose of the Study:
- To determine if malignant LVH identifies community-dwelling adults without prevalent cardiovascular disease at high risk for asymptomatic decline in left ventricular ejection fraction or clinical cardiovascular events.
Main Methods:
- Utilized data from 4985 individuals without prevalent cardiovascular disease from the MESA study.
- Assessed baseline left ventricular hypertrophy (LVH) via cardiac magnetic resonance and measured cardiac biomarkers (high-sensitivity troponin T, amino-terminal pro-B-type natriuretic peptide).
- Categorized participants into four groups and followed them for a median of 12.2 years, reassessing LV ejection fraction via cardiac magnetic resonance after 10 years.
Main Results:
- Malignant LVH (LVH with elevated biomarkers) was identified in 7.0% of the study population.
- Malignant LVH was associated with significantly increased adjusted risks for incident heart failure (7.0-fold), cardiovascular death (3.5-fold), and asymptomatic LV dysfunction (2.6-fold) compared to no LVH and no elevated biomarkers.
- New-onset heart failure was predominantly of the reduced ejection fraction type, with a 9.5-fold increase in this subgroup.
Conclusions:
- Malignant LVH is a potent predictor of progression to asymptomatic LV dysfunction, heart failure (especially HF with reduced ejection fraction), and cardiovascular death.
- This phenotype represents a high-risk group among individuals without known cardiovascular disease.
- Targeted surveillance and more aggressive therapies are recommended for individuals identified with malignant LVH.
Background:
As heart failure (HF)-associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. "Malignant" left ventricular (LV) hypertrophy (LVH): LVH combined with an elevated cardiac biomarker reflecting either injury (high-sensitivity cardiac troponin T), or strain (amino-terminal pro-B-type natriuretic peptide) has predicted accelerated progression to HF. We sought to determine whether malignant LVH identified community-dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in LV ejection fraction or a clinical cardiovascular event.
Methods And Results:
A total of 4985 of 6814 individuals without prevalent cardiovascular disease underwent baseline cardiac magnetic resonance for LVH in combination with measurement of plasma high-sensitivity cardiac troponin T and amino-terminal pro-B-type natriuretic peptide as part of MESA (Multi-Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No LVH, no elevated biomarkers (n=2206; 44.3%); (2) No LVH, ≥1 elevated biomarkers (n=2275; 45.7%); (3) LVH, no elevated biomarkers (n=153; 3.0%); and (4) LVH, ≥1 elevated biomarkers (malignant LVH; n=351; 7.0%). Cardiac magnetic resonance was repeated 10 years later (n=2831) for assessment of LV ejection fraction <50%. Median follow-up was 12.2 years. Malignant LVH was associated with 7.0-, 3.5-, and 2.6-fold adjusted increases in incidence of HF, cardiovascular death, and asymptomatic LV dysfunction, respectively, versus group 1. New-onset HF was predominately HF with reduced ejection fraction (9.5-fold increase).
Conclusions:
Malignant LVH is predictive of progression to asymptomatic LV dysfunction, HF (particularly HF with reduced ejection fraction), and cardiovascular death. Consequently, malignant LVH represents a high-risk phenotype among individuals without known cardiovascular disease, which should be targeted for increased surveillance and more-aggressive therapies.