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The relative effects of left ventricular hypertrophy, coronary artery disease, and ventricular dysfunction on
Y Liao1, R S Cooper, D L McGee
1Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Ill 60153, USA.
Insights
Left ventricular hypertrophy (LVH) significantly impacts survival more than coronary artery disease severity in black patients. This finding highlights LVH as a critical, independent risk factor for adverse outcomes in heart disease.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Left ventricular hypertrophy (LVH) is a common cardiac adaptation.
- Its prognostic significance relative to coronary artery disease (CAD) severity requires further elucidation.
- Understanding these factors is crucial for managing cardiovascular risk, particularly in specific populations.
Purpose of the Study:
- To compare the impact of echocardiographically determined LVH on survival.
- To assess LVH's effect against the number of stenosed coronary vessels and left ventricular systolic dysfunction.
- To evaluate LVH as an independent predictor of mortality in a cohort of black patients.
Main Methods:
- A cohort study was conducted using a consecutive sample from a hospital registry.
- 1089 black patients underwent coronary angiography and echocardiography.
- Mean follow-up was 5 years, with analysis including multivariate models.
Main Results:
- LVH was detected in 50% of patients.
- LVH conferred a relative risk (RR) of 2.4 for mortality, exceeding that of multivessel disease (RR 1.6) and ventricular dysfunction (RR 2.0).
- LVH independently accounted for 37% of deaths in the cohort, significantly higher than other factors.
Conclusions:
- Left ventricular hypertrophy is a stronger predictor of mortality than traditional measures of coronary disease severity.
- The high prevalence and potent risk associated with LVH contribute significantly to adverse survival rates in black patients with heart disease.
- LVH may explain a substantial portion of the observed black-white disparities in cardiovascular outcomes.
Objective:
To evaluate the effect of echocardiographically determined left ventricular hypertrophy (LVH) on survival in comparison with number of stenosed vessels and left ventricular systolic dysfunction.
Design:
Cohort study based on a consecutive sample from a hospital registry, with a mean follow-up of 5 years.
Setting:
An inner-city public hospital in Chicago, Ill.
Patients:
The study included 1089 consecutive black patients who underwent both coronary angiography and M-mode echocardiography as part of a diagnostic evaluation.
Results:
Nonstenosed coronary arteries, single-vessel disease, and multivessel disease were found in 48%, 16%, and 36% of patients, respectively; LVH (left ventricular mass index > 131 g/m2 in men and > 100 g/m2 in women) was detected in 50% of patients. Hypertrophy without coexistent obstructive coronary disease was associated with a lower survival rate than that observed for single-vessel disease and was similar to multivessel disease. When LVH, number of diseases vessels, and left ventricular dysfunction were subjected to multivariate analysis, hypertrophy conferred a relative risk (RR) of 2.4 (95% confidence interval [CI], 1.7 to 3.2). By comparison, the presence of a single stenosed vessel did not increase the risk of death. Multivessel disease and ejection fraction less than 45% were associated with an RR of 1.6 (95% CI, 1.1 to 2.2) and 2.0 (95% CI, 1.4 to 2.7), respectively. Calculation of the attributable risk fraction demonstrated that for every 100 deaths in this cohort, LVH independently accounted for 37. The corresponding attributable risk fractions were 1%, 22%, and 9% for single-vessel disease, multivessel disease, and ventricular dysfunction, respectively.
Conclusions:
Left ventricular hypertrophy was associated with a greater RR and attributable risk than the traditional measures of coronary disease severity. The high prevalence and powerful risk of LVH make an important contribution to the adverse survival rates among black patients with heart disease and may account for much of the black-white differential.
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