title: Left ventricular hypertrophy patterns and incidence of heart failure with preserved versus reduced ejection fraction.
abstract: Higher left ventricular (LV) mass, wall thickness, and internal dimension are associated with increased heart failure (HF) risk. Whether different LV hypertrophy patterns vary with respect to rates and types of HF incidence is unclear. In this study, 4,768 Framingham Heart Study participants (mean age 50 years, 56% women) were classified into 4 mutually exclusive LV hypertrophy pattern groups (normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy) using American Society of Echocardiography-recommended thresholds of echocardiographic LV mass indexed to body surface area and relative wall thickness, and these groups were related to HF incidence. Whether risk for HF types (HF with reduced ejection fraction [<45%] vs preserved ejection fraction [≥45%]) varied by hypertrophy pattern was then evaluated. On follow-up (mean 21 years), 458 participants (9.6%, 250 women) developed new-onset HF. The age- and gender-adjusted 20-year HF incidence increased from 6.96% in the normal left ventricle group to 8.67%, 13.38%, and 15.27% in the concentric remodeling, concentric hypertrophy, and eccentric hypertrophy groups, respectively. After adjustment for co-morbidities and incident myocardial infarction, LV hypertrophy patterns were associated with higher HF incidence relative to the normal left ventricle group (p = 0.0002); eccentric hypertrophy carried the greatest risk (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.41 to 2.54), followed by concentric hypertrophy (HR 1.40, 95% CI 1.04 to 1.87). Participants with eccentric hypertrophy had a higher propensity for HF with reduced ejection fraction (HR 2.23, 95% CI 1.48 to 3.37), whereas those with concentric hypertrophy were more prone to HF with preserved ejection fraction (HR 1.66, 95% CI 1.09 to 2.51). In conclusion, in this large community-based sample, HF risk varied by LV hypertrophy pattern, with eccentric and concentric hypertrophy predisposing to HF with reduced and preserved ejection fraction, respectively.
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Division of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Raghava S
authors.initials: RS
authors.lastname: Velagaleti
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Philimon
authors.initials: P
authors.lastname: Gona
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Veterans Administration Hospital, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Jayashri
authors.initials: J
authors.lastname: Aragam
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.affiliation: Institute for Clinical Evaluative Sciences and Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts.
authors.forename: William B
authors.initials: WB
authors.lastname: Kannel
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Preventive Medicine & Cardiology Sections, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Preventive Medicine & Cardiology Sections, Boston University School of Medicine, Boston, Massachusetts. Electronic address: vasan@bu.edu.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D014481:United States / Q000453:epidemiology