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 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.


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.


BACKGROUND
http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.). casperbang@hotmail.com.
Casper N
CN
Bang
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Eva
E
Gerdts
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Gerard P
GP
Aurigemma
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Kurt
K
Boman
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Giovanni
G
de Simone
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Björn
B
Dahlöf
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Lars
L
Køber
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Kristian
K
Wachtell
From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
Richard B
RB
Devereux
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001262:Atenolol / Q000627:therapeutic use; D002423:Cause of Death; D003643:Death; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology; D009929:Organ Size; D016016:Proportional Hazards Models; D020521:Stroke / Q000150:complications / Q000473:pathology
D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan
hypertension; hypertrophy; left ventricular geometry