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Impact of Height Exponents on the Diagnosis and Prognosis of LVH: The REMODEL Study
Clement Lee1, Ryan Chan2, Desiree-Faye Toh3
1University of Dundee, Dundee, Scotland.
Insights
New height exponents for left ventricular hypertrophy (LVH) improve LV mass normalization but do not enhance cardiovascular event prediction. Sex-specific exponents are crucial for accurate LVH diagnosis in diverse populations.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Cardiac Remodeling and Hypertrophy
- Predictive Analytics in Cardiology
Background:
- Left ventricular hypertrophy (LVH) is a significant predictor of adverse cardiovascular outcomes.
- Current methods for normalizing left ventricular mass (LVM) to body size using height exponents lack standardized recommendations.
- A scarcity of normal reference cohorts hinders the definition of appropriate height exponents for LVH assessment.
Purpose of the Study:
- To establish sex- and ethnicity-specific height exponents for left ventricular mass (LVM) normalization.
- To evaluate the diagnostic and prognostic implications of these novel height exponents in cardiovascular magnetic resonance imaging (CMR).
- To assess the impact of sex-specific height exponents on LVH reclassification and event prediction in hypertensive patients.
Main Methods:
- Established height exponents using a cohort of 416 healthy, nonoverweight/nonobese Asian volunteers.
- Assessed the impact of these exponents in a separate cohort of 878 Asian hypertensive subjects using CMR.
- Defined the primary outcome as a composite of acute coronary syndrome, heart failure hospitalization, stroke, and cardiovascular mortality.
Main Results:
- Derived sex-specific height exponents: 1.57 for females and 2.33 for males.
- Utilizing sex-specific height exponents increased LVH prevalence from 27% to 47% in hypertensive patients, primarily reclassifying overweight/obese individuals.
- Both indexing methods (height exponent and body surface area) independently associated LVH with increased adverse events, with no significant difference in predictive accuracy.
Conclusions:
- Reference ranges for height exponents should be specific to ethnicity, sex, and imaging modality for accurate LVH assessment.
- While height exponents led to significant LVH reclassification, they did not improve the prediction of cardiovascular events.
- Further research is needed to refine LVH normalization techniques and their prognostic value.
Background:
Left ventricular hypertrophy (LVH) is a strong predictor of adverse outcomes. Although normalizing LV mass (LVM) to height exponents reduced variability from body size, specific recommendations for height exponents are lacking due to a scarcity of normal cohorts to define appropriate height exponents.
Objectives:
The authors aimed to show the diagnostic and prognostic implications of establishing height exponents specific to sex, ethnicity, and imaging modality.
Methods:
Nonoverweight/nonobese Asian healthy volunteers (n = 416) were used to establish appropriate height exponents. The impact of these height exponents was examined in a separate cohort of Asian subjects with hypertension (n = 878). All individuals underwent standardized cardiovascular magnetic resonance imaging. The primary outcome was a composite of acute coronary syndrome, heart failure hospitalization, stroke, and cardiovascular mortality.
Results:
The height exponents for healthy female subjects and male subjects were 1.57 and 2.33, respectively. LVH was present in 27% of individuals with hypertension when indexed to body surface area and 47% when indexed to sex-specific height exponents. Most individuals reclassified to LVH with height exponents were overweight or obese. There were 37 adverse events over 60 months (37-73 months) of follow-up. Regardless of indexing method, LVH was independently associated with increased adverse events (height exponent HR: 2.80 [95% CI: 1.25-6.29; P = 0.013]; body surface area HR: 5.43 [95% CI: 2.49-11.8; P < 0.001]).
Conclusions:
Reference ranges specific to ethnicity, sex, and imaging modality are necessary to establish appropriate height exponents. Although using height exponents resulted in more LVH reclassification, this did not translate to a notable improvement in event prediction.
