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Am J Cardiol. 2014 Jan 1;113(1):117-22. doi: 10.1016/j.amjcard.2013.09.028. Epub 2013 Oct 4.

Left ventricular hypertrophy patterns and incidence of heart failure with preserved versus reduced ejection fraction.

Author information

1
Framingham Heart Study, Framingham, Massachusetts; Division of Cardiology, University of Massachusetts Medical School, Worcester, Massachusetts.
2
Framingham Heart Study, Framingham, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
3
Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.
4
Veterans Administration Hospital, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
5
Harvard Medical School, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
6
Framingham Heart Study, Framingham, Massachusetts; Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
7
Institute for Clinical Evaluative Sciences and Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
8
Framingham Heart Study, Framingham, Massachusetts.
9
Framingham Heart Study, Framingham, Massachusetts; Preventive Medicine & Cardiology Sections, Boston University School of Medicine, Boston, Massachusetts.
10
Framingham Heart Study, Framingham, Massachusetts; Preventive Medicine & Cardiology Sections, Boston University School of Medicine, Boston, Massachusetts. Electronic address: vasan@bu.edu.

Abstract

Higher left ventricular (LV) mass, wall thickness, and internal dimension are associated with increased heart failure (HF) risk. Whether different LV hypertrophy patterns vary with respect to rates and types of HF incidence is unclear. In this study, 4,768 Framingham Heart Study participants (mean age 50 years, 56% women) were classified into 4 mutually exclusive LV hypertrophy pattern groups (normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy) using American Society of Echocardiography-recommended thresholds of echocardiographic LV mass indexed to body surface area and relative wall thickness, and these groups were related to HF incidence. Whether risk for HF types (HF with reduced ejection fraction [<45%] vs preserved ejection fraction [≥45%]) varied by hypertrophy pattern was then evaluated. On follow-up (mean 21 years), 458 participants (9.6%, 250 women) developed new-onset HF. The age- and gender-adjusted 20-year HF incidence increased from 6.96% in the normal left ventricle group to 8.67%, 13.38%, and 15.27% in the concentric remodeling, concentric hypertrophy, and eccentric hypertrophy groups, respectively. After adjustment for co-morbidities and incident myocardial infarction, LV hypertrophy patterns were associated with higher HF incidence relative to the normal left ventricle group (p = 0.0002); eccentric hypertrophy carried the greatest risk (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.41 to 2.54), followed by concentric hypertrophy (HR 1.40, 95% CI 1.04 to 1.87). Participants with eccentric hypertrophy had a higher propensity for HF with reduced ejection fraction (HR 2.23, 95% CI 1.48 to 3.37), whereas those with concentric hypertrophy were more prone to HF with preserved ejection fraction (HR 1.66, 95% CI 1.09 to 2.51). In conclusion, in this large community-based sample, HF risk varied by LV hypertrophy pattern, with eccentric and concentric hypertrophy predisposing to HF with reduced and preserved ejection fraction, respectively.

PMID:
24210333
PMCID:
PMC3881171
DOI:
10.1016/j.amjcard.2013.09.028
[Indexed for MEDLINE]
Free PMC Article

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