title: The natural history of left ventricular geometry in the community: clinical correlates and prognostic significance of change in LV geometric pattern.
abstract: OBJECTIVE
  This study sought to evaluate pattern and clinical correlates of change in left ventricular (LV) geometry over a 4-year period in the community; it also assessed whether the pattern of change in LV geometry over 4 years predicts incident cardiovascular disease (CVD), including myocardial infarction, heart failure, and cardiovascular death, during an additional subsequent follow-up period.
  
  
  BACKGROUND
  It is unclear how LV geometric patterns change over time and whether changes in LV geometry have prognostic significance.
  
  
  METHODS
  This study evaluated 4,492 observations (2,604 unique Framingham Heart Study participants attending consecutive examinations) to categorize LV geometry at baseline and after 4 years. Four groups were defined on the basis of the sex-specific distributions of left ventricular mass (LVM) and relative wall thickness (RWT) (normal: LVM and RWT <80th percentile; concentric remodeling: LVM <80th percentile but RWT ≥80th percentile; eccentric hypertrophy: LVM ≥80th percentile but RWT <80th percentile; and concentric hypertrophy: LVM and RWT ≥80th percentile).
  
  
  RESULTS
  At baseline, 2,874 of 4,492 observations (64%) had normal LVM and RWT. Participants with normal geometry or concentric remodeling progressed infrequently (4% to 8%) to eccentric or concentric hypertrophy. Change from eccentric to concentric hypertrophy was uncommon (8%). Among participants with concentric hypertrophy, 19% developed eccentric hypertrophy within the 4-year period. Among participants with abnormal LV geometry at baseline, a significant proportion (29% to 53%) reverted to normal geometry within 4 years. Higher blood pressure, greater body mass index (BMI), advancing age, and male sex were key correlates of developing an abnormal geometry. Development of an abnormal LV geometric pattern over 4 years was associated with increased CVD risk (140 events) during a subsequent median follow-up of 12 years (adjusted-hazards ratio: 1.59; 95% confidence interval: 1.04 to 2.43).
  
  
  CONCLUSIONS
  The longitudinal observations in the community suggest that dynamic changes in LV geometric pattern over time are common. Higher blood pressure and greater BMI are modifiable factors associated with the development of abnormal LV geometry, and such progression portends an adverse prognosis.
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lieb
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; University of Massachusetts Boston, Boston, 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: Martin G
authors.initials: MG
authors.lastname: Larson
authors.affiliation: Boston Veterans Affairs Health Care System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Jayashri
authors.initials: J
authors.lastname: Aragam
authors.affiliation: Medical University of South Carolina and Department of Veterans Affairs Medical, Charleston, South Carolina.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Whitaker Cardiovascular Institute, Preventive Medicine and Cardiology Sections, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Framingham Heart Study, Framingham, Massachusetts; Whitaker Cardiovascular Institute, Preventive Medicine and Cardiology Sections, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts. Electronic address: vasan@bu.edu.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: LV geometry; cardiovascular disease; change over time; echocardiography; epidemiology; heart failure; remodeling