Author + information
- Received May 13, 2015
- Revision received June 24, 2015
- Accepted June 25, 2015
- Published online September 1, 2015.
- Sonia Garg, MD, MEng∗,
- James A. de Lemos, MD∗,
- Colby Ayers, MS†,
- Michel G. Khouri, MD‡,
- Ambarish Pandey, MD∗,
- Jarett D. Berry, MD, MS∗,†,
- Ronald M. Peshock, MD∗,§ and
- Mark H. Drazner, MD, MSc∗∗ ()
- ∗Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- †Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas
- ‡Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina
- §Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
- ↵∗Reprint requests and correspondence:
Dr. Mark Drazner, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390-9047.
Objectives This study was performed to determine whether a 4-tiered classification of left ventricular hypertrophy (LVH) defines subgroups in the general population that are at variable risks of adverse cardiovascular (CV) outcomes.
Background We recently proposed a 4-tiered classification of LVH where eccentric LVH is subdivided into “indeterminate hypertrophy” and “dilated hypertrophy” and concentric LVH into “thick hypertrophy” and “both thick and dilated hypertrophy,” based on the presence of increased left ventricular (LV) end-diastolic volume.
Methods Participants from the Dallas Heart study who underwent cardiac magnetic resonance and did not have LV dysfunction or a history of heart failure (HF) (n = 2,458) were followed for a median of 9 years for the primary outcome of HF or CV death. Multivariable Cox proportional hazards models were used to adjust for age, sex, African-American race, hypertension, diabetes, and history of CV disease.
Results In the cohort, 70% had no LVH, 404 (16%) had indeterminate hypertrophy, 30 (1%) had dilated hypertrophy, 289 (12%) had thick hypertrophy, and 7 (0.2%) had both thick and dilated hypertrophy. The cumulative incidence of HF or CV death was 2% with no LVH, 1.7% with indeterminate, 16.7% with dilated, 11.1% with thick, and 42.9% with both thick and dilated hypertrophy (log-rank p < 0.0001). Compared with participants without LVH, those with dilated (hazard ratio [HR]: 7.3; 95% confidence interval [CI]: 2.8 to 18.8), thick (HR: 2.4; 95% CI: 1.4 to 4.0), and both thick and dilated (HR: 5.8; 95% CI: 1.7 to 19.5) hypertrophy remained at increased risk for HF or CV death after multivariable adjustment, whereas the group with indeterminate hypertrophy was not (HR: 0.9; 95% CI: 0.4 to 2.2).
Conclusions In the general population, the 4-tiered classification system for LVH stratified LVH into subgroups with differential risk of adverse CV outcomes.
The Dallas Heart Study was funded by the Donald W. Reynolds Foundation and was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health [UL1TR001105]. Dr. Drazner has received support from the James M. Wooten Chair in Cardiology, University of Texas Southwestern Medical Center. Drs. de Lemos, Berry, and Drazner are funded by the American Heart Association Strategically Focused Research Grant [14SFRN20740000]. Dr. de Lemos has received grant support from Roche Diagnostics and Abbott Diagnostics. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
- Received May 13, 2015.
- Revision received June 24, 2015.
- Accepted June 25, 2015.
- 2015 American College of Cardiology Foundation