Left ventricular mass and geometry and the risk of ischemic stroke.
OBJECTIVE
Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular events, but its effect on ischemic stroke risk is established mainly in whites. The effect of LV geometry on stroke risk has not been defined. The aim of the present study was to evaluate whether LVH and LV geometry are independently associated with increased ischemic stroke risk in a multiethnic population.


METHODS
A population-based case-control study was conducted on 394 patients with first ischemic stroke and 413 age-, sex-, and race-ethnicity-matched community control subjects. LV mass was measured by transthoracic echocardiography. LV geometric patterns (normal, concentric remodeling, concentric or eccentric hypertrophy) were identified. Stroke risk associated with LVH and different LV geometric patterns was assessed by conditional logistic regression analysis in the overall group and age, sex, and race-ethnic strata, with adjustment for established stroke risk factors.


RESULTS
Concentric hypertrophy carried the greatest stroke risk (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 2.0 to 6.2), followed by eccentric hypertrophy (adjusted OR, 2.4; 95% CI, 2.0 to 4.3). Concentric remodeling carried slightly increased stroke risk (adjusted OR, 1.7; 95% CI, 1.0 to 2.9). Increased LV relative wall thickness was independently associated with stroke after adjustment for LV mass (OR, 1.6; 95% CI, 1.1 to 2.3).


CONCLUSIONS
LVH and abnormal LV geometry are independently associated with increased stroke risk. LVH is strongly associated with ischemic stroke in all age, sex, and race-ethnic subgroups. Increased LV relative wall thickness imparts an increased stroke risk after adjustment for LV mass and is of additional value in stroke risk prediction.
Di Tullio
Marco R
MR
Department of Medicine,Sergievsky Center, Columbia-Presbyterian Medical Center, 630 W 168th St, New York, NY 10032, USA. md42@columbia.edu
Zwas
Donna R
DR
Sacco
Ralph L
RL
Sciacca
Robert R
RR
Homma
Shunichi
S
D017677:Age Distribution; D000368:Aged; D044383:Black People; D002545:Brain Ischemia / Q000453:epidemiology* / Q000208:ethnology; D016022:Case-Control Studies; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000208:ethnology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D008297:Male; D009519:New York City / Q000453:epidemiology / Q000208:ethnology; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology; D020257:Ventricular Remodeling; D044465:White People; D001741:Black or African American