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Prognostic implications of left ventricular hypertrophy defined by the thresholds from the international and Chinese

Dan Zhou1, Mengqi Yan1, Anping Cai1,2

  • 1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.

Journal of Clinical Hypertension (Greenwich, Conn.)
|June 19, 2023
PubMed

Insights

Chinese thresholds for left ventricular hypertrophy (LVH) better predict mortality in hypertensive patients than international guidelines. Using race-specific thresholds and indexing left ventricular mass (LVM) to BSA or height^1.7 improves risk stratification.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Medical Statistics

Background:

  • Left ventricular hypertrophy (LVH) is a significant predictor of mortality in hypertensive individuals.
  • Current international guidelines for defining LVH may not be optimal for all populations.
  • Accurate LVH assessment is crucial for cardiovascular risk stratification.

Purpose of the Study:

  • To compare the predictive value of mortality between LVH defined by Chinese thresholds and international guidelines in Chinese hypertensive patients.
  • To identify optimal methods for indexing left ventricular mass (LVM) in the Chinese population for LVH assessment.
  • To investigate the association between different LVH definitions and all-cause and cardiovascular mortality.

Main Methods:

  • A cohort of 2454 community hypertensive patients with measured LVM and relative wall thickness was analyzed.
  • LVM was indexed to body surface area (BSA), height^2.7, and height^1.7.
  • Cox proportional hazards models, C-statistics, and time-dependent ROC curves were used to evaluate LVH prediction of mortality.

Main Results:

  • LVH defined by Chinese thresholds (LVM/BSA) was significantly associated with cardiovascular mortality.
  • Both LVM/BSA and LVM/Height^1.7, using Chinese thresholds, showed significant associations with all-cause mortality.
  • Chinese thresholds for LVM/BSA and LVM/Height^1.7 demonstrated superior predictive ability for mortality compared to international guidelines.

Conclusions:

  • Race-specific thresholds are recommended for classifying LVH and improving mortality risk stratification in Chinese hypertensive populations.
  • LVM indexed to BSA and height^1.7 are acceptable normalization methods for LVH assessment in Chinese hypertensive patients.
  • Utilizing appropriate LVH definitions and indexing methods enhances the prediction of adverse outcomes in hypertension.

Keywords:
Chinese thresholdall-cause mortalitycardiovascular mortalityguideline thresholdsleft ventricular hypertrophy

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