Concentric left ventricular hypertrophy as assessed by cardiac magnetic resonance imaging and risk of death in cardiac transplant recipients.
BACKGROUND
Although risk factors for left ventricular (LV) hypertrophy in the native heart are well known, as is its association with increased risk of adverse outcomes, such information is poorly defined in heart transplant (HTx) recipients. We determined whether increased LV mass and concentricity (mass/volume) were associated with death in patients after HTx.


METHODS
Between May 2003 and May 2006, 140 HTx recipients underwent cardiac magnetic resonance imaging (MRI). Clinical characteristics associated with increased LV mass were determined. Cox proportional hazard models were constructed to assess the relationship of LV mass and concentricity with death.


RESULTS
MRIs were acquired a median of 6.0 years after transplant. The top quartile of indexed LV mass and concentricity were 35.8 g/m(2.7) or higher and 1.5 g/ml or higher, respectively. History of rejection (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.1-16.4; p < 0.01), diabetes (OR, 3.3; 95% CI, 1.3-8.2; p = 0.01), and post-transplant year of MRI acquisition (OR, 1.2; 95% CI, 1.1-1.4; p < 0.01) were associated with the top quartile of LV mass in multivariable models. LV mass and concentricity were independently associated with cardiovascular death (hazard risk [HR], 1.11 per g/m;(2.7) HR, 10.1 per g/ml, p ≤ 0.01, respectively). LV concentricity was independently associated with all-cause mortality (HR, 4.4 per g/ml, p < 0.01).


CONCLUSIONS
A history of rejection and diabetes are associated with increased LV mass. Increased LV mass, particularly of a concentric phenotype, is an independent risk factor for cardiovascular and all-cause mortality after HTx.
Patel
Parag C
PC
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA. parag.patel@utsouthwestern.edu
Reimold
Sharon C
SC
Araj
Faris G
FG
Ayers
Colby R
CR
Kaiser
Patricia A
PA
Peshock
Ronald M
RM
Yancy
Clyde W
CW
Ring
W Steves
WS
Gupta
Sachin
S
Mishkin
Joseph D
JD
Mammen
Pradeep P A
PP
Markham
David W
DW
Drazner
Mark H
MH
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult