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Concentric vs. eccentric remodelling in heart failure with reduced ejection fraction: clinical characteristics,

Jan F Nauta1, Yoran M Hummel1, Jasper Tromp1

  • 1Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

European Journal of Heart Failure
|November 13, 2019
PubMed

Insights

Heart failure with reduced ejection fraction (HFrEF) patients with concentric hypertrophy show distinct clinical and biomarker profiles. Concentric hypertrophy may limit benefits from beta-blocker and ACE inhibitor/ARB therapies compared to eccentric hypertrophy.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Clinical Biomarkers

Background:

  • Heart failure classification traditionally relies on left ventricular ejection fraction (LVEF), guiding therapies for HFrEF but not HFpEF.
  • While most HFrEF patients exhibit eccentric LV hypertrophy, a subset presents with concentric LV hypertrophy.
  • Understanding differences between these geometric patterns is crucial for personalized treatment strategies.

Purpose of the Study:

  • To compare clinical characteristics, biomarker profiles, and treatment responses in HFrEF patients with eccentric versus concentric LV hypertrophy.
  • To identify distinct pathophysiologic pathways associated with each LV geometry in HFrEF.
  • To evaluate the differential impact of guideline-directed medical therapies on outcomes based on LV geometry.

Main Methods:

  • Retrospective post-hoc analysis of 1015 HFrEF patients from the BIOSTAT-CHF study.
  • Classification of LV geometry using two-dimensional echocardiography.
  • Network analysis of 92 biomarkers to explore pathophysiologic differences.

Main Results:

  • Concentric LV hypertrophy was identified in 14% of patients, who were older and more hypertensive than those with eccentric hypertrophy.
  • Biomarker network analysis revealed distinct central hubs: NT-proBNP in eccentric, and TNF-R1, uPAR, PON, and P-selectin in concentric hypertrophy.
  • Upregulation of beta-blockers improved mortality in eccentric HFrEF but not concentric HFrEF (P-interaction ≤0.001).

Conclusions:

  • HFrEF patients with concentric hypertrophy possess unique clinical and biomarker phenotypes compared to those with eccentric hypertrophy.
  • The mortality benefit of beta-blocker titration may be attenuated in patients with concentric LV hypertrophy.
  • Further research is needed to optimize therapies for HFrEF patients with concentric hypertrophy.
Abstract

Keywords:
BiomarkersConcentric hypertrophyEccentric hypertrophyEchocardiographyHeart failureHeart failure with reduced ejection fractionLeft ventricular geometryMedical therapy

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