Four-Group Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies a Low-Risk Subset of Eccentric Hypertrophy in Hypertensive Patients

被引:89
作者
Bang, Casper N. [1 ,2 ]
Gerdts, Eva [3 ]
Aurigemma, Gerard P. [4 ]
Boman, Kurt [5 ]
de Simone, Giovanni [1 ,6 ]
Dahlof, Bjorn [7 ]
Kober, Lars [2 ]
Wachtell, Kristian [1 ,8 ]
Devereux, Richard B. [1 ]
机构
[1] Weill Cornell Med Coll, Dept Med, New York, NY USA
[2] Rigshosp, Ctr Heart, Dept Cardiol, DK-2100 Copenhagen, Denmark
[3] Univ Bergen, Dept Clin Sci, Bergen, Norway
[4] Univ Massachusetts, Sch Med, Dept Med, Div Cardiol, Worcester, MA USA
[5] Umea Univ, Inst Publ Hlth & Clin Med, Dept Med, Umea, Sweden
[6] Univ Naples Federico II, Dept Translat Med Sci, Naples, Italy
[7] Sahlgrens Univ Hosp, Dept Med, Gothenburg, Sweden
[8] Univ Copenhagen, Glostrup Hosp, Dept Cardiol, Glostrup, Denmark
关键词
hypertension; hypertrophy; left ventricular geometry; END-POINT REDUCTION; HEART-FAILURE; LOSARTAN INTERVENTION; ECHOCARDIOGRAPHIC-ASSESSMENT; PROGNOSTIC IMPLICATIONS; GEOMETRIC PATTERNS; LIFE; MASS; IMPACT; RECLASSIFICATION;
D O I
10.1161/CIRCIMAGING.113.001275
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Left ventricular hypertrophy (LVH; high LV mass [LVM]) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of subsequent adverse events in a new 4-group LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV](2/3)) in hypertensive patients. Methods and Results-In the Losartan Intervention for Endpoint Reduction (LIFE) echocardiography substudy, 939 hypertensive patients with measurable LVM at baseline were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. Patients with LVH (LVM/body surface area >= 116 and >= 96 g/m(2) in men and woman, respectively) were divided into 4 groups-concentric nondilated (increased M/EDV, normal EDV), eccentric dilated (increased EDV, normal M/EDV), concentric dilated (increased M/EDV and EDV), and eccentric nondilated (normal M/EDV and EDV)-and compared with patients with normal LVM. Time-varying LVH classes were tested for association with all-cause and cardiovascular mortality and a composite end point of myocardial infarction, stroke, heart failure, and cardiovascular death in multivariable Cox analyses. At baseline, the LVs were categorized as eccentric nondilated in 12%, eccentric dilated in 20%, concentric nondilated in 29%, concentric dilated in 14%, and normal LVM in 25%. Treatment changed the prevalence of 4 LVH groups to 23%, 4%, 5%, and 7%; 62% had normal LVM after 4 years. In time-varying Cox analyses, compared with normal LVM, those with eccentric dilated and both concentric nondilated and dilated LVH had increased risks of all-cause or cardiovascular mortality or the composite end point, whereas the eccentric nondilated group did not. Conclusions-Hypertensive patients with relatively mild LVH without either increased LV volume or concentricity have similar risk of all-cause mortality or cardiovascular events because hypertensive patients with normal LVM seem to be a low-risk group.
引用
收藏
页码:422 / U20
页数:9
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