title: Risk of mortality in relation to an updated classification of left ventricular geometric abnormalities in a general population: the Pamela study.
abstract: OBJECTIVE
  We estimated the risk of cardiovascular and all-cause mortality associated with left ventricular geometric patterns, as defined by a new classification system proposed by the Dallas Heart Study, in 1716 representatives of the general population of Monza enrolled in the Pressioni Monitorate e Loro Associazioni (PAMELA) study.
  
  
  METHODS
  Cut-points for abnormal left ventricular geometric patterns were derived from reference values of the healthy fraction of the PAMELA population by combining left ventricular mass (LVM) index, left ventricular diameter and relative wall thickness. Death certificates were collected over an average 211 months follow-up period.
  
  
  RESULTS
  During follow-up, 89 fatal cardiovascular events and 264 all-cause deaths were recorded. Concentric remodelling was the most common left ventricular geometric abnormality (9.4%) followed by eccentric nondilated left ventricular hypertrophy (LVH) (6.3%), concentric LVH (4.6%) and eccentric dilated LVH (3.5%). Compared with normal left ventricular geometry, concentric LVH [hazard ratio 2.20, 95% confidence interval (95% CI) 1.44-3.37, P < 0.0003], eccentric dilated LVH (hazard ratio 1.90, 95% CI 1.17-3.08, P = 0.009) and eccentric nondilated LVH (hazard ratio 1.57, 95% CI 1.07-2.31, P = 0.02) predicted the risk of cardiovascular mortality, after adjustment for baseline covariates, including ambulatory blood pressure. Similar findings were observed for all-cause mortality. Only concentric LVH maintained a significant prognostic value for both outcomes after adjustment for baseline differences in LVM index.
  
  
  CONCLUSIONS
  The new classification system of left ventricular geometric patterns may improve mortality risk stratification in a general population. The risk is markedly dependent on LVM values; only concentric LVH provides a prognostic information beyond that conveyed by cardiac mass.
authors.affiliation: aDepartment of Health Science, University of Milano-Bicocca bIstituto Auxologico Italiano IRCCS cDepartment of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milan, Italy dUniversity Clinical Hospital Centre 'Dragisa Misovic', Belgrade, Serbia eIRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Rita
authors.initials: R
authors.lastname: Facchetti
authors.forename: Michele
authors.initials: M
authors.lastname: Bombelli
authors.forename: Carla
authors.initials: C
authors.lastname: Sala
authors.forename: Marijana
authors.initials: M
authors.lastname: Tadic
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000145:classification* / Q000000981:diagnostic imaging / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D014463:Ultrasonography; D020257:Ventricular Remodeling