title: Subclassification of left ventricular hypertrophy based on dilation stratifies coronary artery disease patients with distinct risk.
abstract: BACKGROUND
  A new 4-tired classification of left ventricular hypertrophy (LVH) based on LV concentricity and dilation has been proposed; however, the association between the new categorization of LV geometry and outcomes in patients with coronary artery disease (CAD) is still unknown.
  
  
  METHODS
  All the 2297 patients with CAD included underwent echocardiographic examination prior to discharge. Left ventricular mass (LVM) was calculated, and left ventricular end-diastolic volume (EDV) was indexed by body surface area (BSA). Study cohort was divided into five groups according to LV geometry: (i) eccentric nondilated LVH (normal LVM/EDV((2/3)) and EDV/BSA) (n = 129); (ii) eccentric dilated LVH (normal LVM/EDV((2/3)) with increased EDV/BSA) (n = 222); (iii) concentric nondilated LVH (increased LVM/EDV((2/3)) with normal EDV/BSA) (n = 441); (iv) concentric dilated LVH (increased LVM/EDV((2/3)) and EDV/BSA) (n = 118); and (v) normal LV mass (n = 1387).
  
  
  RESULTS
  Dilated LVH was associated with a higher event rates of all-cause death (eccentric 13·1% vs. 3·1%; concentric 13·6% vs. 8·4%) and composite events (eccentric: 17·6% vs. 5·4%; concentric: 18·6% vs. 12·7%) compared with nondilated LVH. While eccentric nondilated LVH had comparable risk for adverse outcomes compared with normal LV mass (all-cause death: relative risk (RR) 0·68, 95% confidential interval (CI) 0·25-1·85; composite events: RR 0·75, 95% CI 0·36-1·58). Cox regression analyses showed that eccentric dilated LVH had the highest propensity to all-cause death (adjusted hazard ratio [aHR] 2·752 [95% CI 1·749-4·328], P < 0·001) and composite events (aHR 2·462 [95% CI 1·688-3·592], P < 0·001).
  
  
  CONCLUSIONS
  In patients with CAD, dilated LVH and nondilated LVH provide distinct prognostic information. Eccentric nondilated LVH does not predict adverse outcomes.
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Bao-Tao
authors.initials: BT
authors.lastname: Huang
authors.forename: Yong
authors.initials: Y
authors.lastname: Peng
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.forename: Fang-Yang
authors.initials: FY
authors.lastname: Huang
authors.forename: Peng-Ju
authors.initials: PJ
authors.lastname: Wang
authors.forename: Zhi-Liang
authors.initials: ZL
authors.lastname: Zuo
authors.forename: Yan-Biao
authors.initials: YB
authors.lastname: Liao
authors.forename: Hua
authors.initials: H
authors.lastname: Chai
authors.forename: Qiao
authors.initials: Q
authors.lastname: Li
authors.forename: Zhen-Gang
authors.initials: ZG
authors.lastname: Zhao
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Luo
authors.forename: Xin
authors.initials: X
authors.lastname: Ren
authors.forename: Kai-Sen
authors.initials: KS
authors.lastname: Huang
authors.forename: Qing-Tao
authors.initials: QT
authors.lastname: Meng
authors.forename: Chi
authors.initials: C
authors.lastname: Chen
authors.forename: De-Jia
authors.initials: DJ
authors.lastname: Huang
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
mesh_terms: D017677:Age Distribution; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology; D004452:Echocardiography; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000145:classification* / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020257:Ventricular Remodeling / Q000502:physiology
keywords: Coronary artery disease; echocardiography; left ventricular geometry; left ventricular remoulding