A 4-Tiered Classification of Left Ventricular Hypertrophy Based on Left Ventricular Geometry

Khouri, Michel G.; Peshock, Ronald M; Ayers, Colby; Lemos, James A. de; Drazner, Mark H.

doi:10.1161/circimaging.109.883652

Cited by 188 publications

(177 citation statements)

References 32 publications

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“…Previous studies have reported different values for the upper limit of normal LV mass 13, 28, 29. To address these differences, CMR data on LV mass and concentricity were obtained from 44 healthy subjects (22 men and 22 women).…”

Section: Methodsmentioning

confidence: 99%

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Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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BackgroundApproximately one third of patients with ST‐segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association between LVH and: myocardial infarct size, area at risk, myocardial salvage, microvascular obstruction, left ventricular (LV) function (all determined by cardiac magnetic resonance [CMR]), and all‐cause mortality and readmission for heart failure in STEMI patients treated with primary percutaneous coronary intervention.Methods and ResultsIn this substudy of the DANAMI‐3 trial, 764 patients underwent CMR. LVH was defined by CMR and considered present if LV mass exceeded 77 (men) and 67 g/m2 (women). One hundred seventy‐eight patients (24%) had LVH. LVH was associated with a larger final infarct size (15% [interquartile range {IQR}, 10–21] vs 9% [IQR, 3–17]; P<0.001) and smaller final myocardial salvage index (0.6 [IQR, 0.5–0.7] vs 0.7 [IQR, 0.5–0.9]; P<0.001). The LVH group had a higher incidence of microvascular obstruction (66% vs 45%; P<0.001) and lower final LV ejection fraction (LVEF; 53% [IQR, 47–60] vs 61% [IQR, 55–65]; P<0.001). In a Cox regression analysis, LVH was associated with a higher risk of all‐cause mortality and readmission for heart failure (hazard ratio 2.59 [95% CI, 1.38–4.90], P=0.003). The results remained statistically significant in multivariable models.ConclusionsLVH is independently associated with larger infarct size, less myocardial salvage, higher incidence of microvascular obstruction, lower LVEF, and a higher risk of all‐cause mortality and incidence of heart failure in STEMI patients treated with primary percutaneous coronary intervention.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01435408.

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Section: Methodsmentioning

confidence: 99%

“…LVH is defined as increased LV mass indexed by body surface area (BSA)12 and is divided into eccentric and concentric hypertrophy 13. The utility of this subclassification has previously been demonstrated by significant differences in outcomes between patients with eccentric and concentric LVH 1, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Nepper‐Christensen

Lønborg

Ahtarovski

et al. 2017

JAHA

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“…In that study, patients with LV chamber dilatation, associated with both concentric and eccentric patterns of LVH determined through magnetic resonance imaging, showed lower values of LV ejection fraction and higher levels of troponin 12. The authors suggested to subdivide eccentric and concentric LVH into 2 subgroups based on the absence or presence of LV chamber dilatation 12. In a subsequent analysis of their study, LV dilatation portended a higher risk of cardiovascular death and heart failure regardless of the pattern of eccentric or concentric LVH 27.…”

Section: Discussionmentioning

confidence: 85%

“…The concept of combining LV chamber dilatation with the eccentric and concentric patterns of LVH stemmed from an analysis by Khouri and coworkers of the Dallas Heart Study 12. In that study, patients with LV chamber dilatation, associated with both concentric and eccentric patterns of LVH determined through magnetic resonance imaging, showed lower values of LV ejection fraction and higher levels of troponin 12. The authors suggested to subdivide eccentric and concentric LVH into 2 subgroups based on the absence or presence of LV chamber dilatation 12.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, in a study based on magnetic resonance imaging, Khouri and coworkers12 found a lower LV ejection fraction and higher values of troponin and other surrogate markers of cardiovascular risk in patients with LV chamber dilatation associated with both concentric and eccentric patterns of LVH. Consequently, they suggested reclassifying concentric and eccentric LVH into 2 groups based on the absence or presence of LV dilatation 12…”

Section: Introductionmentioning

confidence: 97%

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Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

Verdecchia¹,

Angeli

Bartolini³

et al. 2017

JAHA

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BackgroundThe different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear.Methods and ResultsWe studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24‐hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow‐up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient‐years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log‐rank test: P<0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24‐hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (P=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model.ConclusionsIn initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.

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Athletic Cardiac Remodeling in US Professional Basketball Players

2016

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A 4-Tiered Classification of Left Ventricular Hypertrophy Based on Left Ventricular Geometry

Abstract: Background-Left ventricular hypertrophy (LVH) is traditionally classified as concentric or eccentric, based on the ratio of LV wall thickness to chamber dimension. We propose a 4-tiered LVH classification based on LV concentricity

Cited by 188 publications

References 32 publications

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

Athletic Cardiac Remodeling in US Professional Basketball Players

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