Four Group Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies a Low-risk Subset of Eccentric Hypertrophy in Hypertensive Patients
Background—Left ventricular (LV) hypertrophy (LVH, high LV mass) 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 (LVM/EDV(2/3)) in hypertensive patients.
Methods and Results—In the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy, 939 patients hypertensive patients with measurable LV mass (LVM) at baseline were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. Patients with LVH (LVM/BSA ≥116 g/m2 in men, ≥96 g/m2 in woman) were divided into 4 groups; "concentric non-dilated" (increased M/EDV with normal EDV), "eccentric dilated" (increased EDV, normal M/EDV) "concentric dilated" (increased M/EDV and EDV), "eccentric non-dilated" (normal M/EDV and EDV) and compared to patients with normal LVM. Time-varying LVH classes were tested for association with all-cause and cardiovascular (CV) mortality and a composite endpoint of myocardial infarction, stroke, heart failure and CV death in multivariable Cox analyses. At baseline, the LVs were categorized as "eccentric non-dilated" in 12%, "eccentric dilated" in 20%, "concentric non-dilated" in 29%, "concentric dilated" in 14% and normal LVM in 25%. Treatment changed prevalence of the 4 LVH groups to 23%, 4%, 5% and 7%; 62% had normal LVM after 4 years. In time-varying Cox analyses, compared to normal LVM, those with eccentric dilated and both concentric non-dilated and dilated LVH had increased risks of all-cause or CV mortality or the composite endpoint, while the eccentric non-dilated 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 CV events as hypertensive patients with normal LVM and appear to be a low risk group.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
- cardiovascular prediction
- left ventricular hypertrophy
- left ventricle geometry
- Received September 4, 2013.
- Accepted March 19, 2014.