Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients

Bang, Casper N.; Gerdts, Eva; Aurigemma, Gerard P.; Boman, Kurt; Dahlof, Bjoern; Roman, Mary J.; Køber, Lars; Wachtell, Kristian; Devereux, Richard B.

doi:10.1097/hjh.0b013e328362bbd6

Cited by 20 publications

(19 citation statements)

References 41 publications

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“…Compared with the nondilated groups, the dilated groups in the present study had increased cardiac output and stroke volume and, therefore, increased wall stress, as well as more segmental wall motion abnormalities. 20 Supporting this finding, although the numbers were small, cardiovascular mortality seemed to be higher in the dilated versus nondilated groups in the present study.…”

Section: Discussionsupporting

confidence: 80%

“…A recent analysis using this model in highrisk hypertensive patients enrolled in the LIFE trial revealed significant differences in hemodynamic and renal function patterns among the 4 groups despite lack of significant differences among the groups in baseline blood pressure. 20 There is consistency in the literature linking concentric LVH with poor outcome, 1,30 whereas published studies report conflicting results on the association between eccentric LVH and outcome. 2,19,29 In the present study, the new 4-group classification system of LVH failed to detect associations of nondilated eccentric LVH with all-cause or cardiovascular mortality or overall cardiovascular events.…”

Section: Discussionmentioning

confidence: 81%

“…6,7,19 Defining LV Geometry LVH and increased LV EDV/BSA were defined according to guidelines (LVM/BSA: ≥96 g/m 2 [women] and ≥116 g/m 2 [men]; LV EDV/BSA: ≥76 mL/m 2 ; Figure 1). 10,20 To identify wall thickening, we used a modified formula to calculate an LV concentricity index as proposed by Khouri et al 4 The concentricity index is calculated as (k×[LV myocardial volume/LV EDV] 2/3 ), as previously described. 4 Sex-specific partitions for LVM/LV EDV 2/3 (termed concentricity 2/3 ) were defined as ≥97.5th percentile of the previously described healthy subpopulation used to define LVH in the Dallas Heart Study 4 (≥8.1 g/ mL 2/3 [women] and ≥9.1 g/mL 2/3 [men]; Figure 1).…”

Section: Doppler Echocardiographymentioning

confidence: 99%

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Four-Group Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies a Low-Risk Subset of Eccentric Hypertrophy in Hypertensive Patients

Bang

Gerdts

Aurigemma

et al. 2014

Circ: Cardiovascular Imaging

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L eft ventricular hypertrophy (LVH), as defined by increased LV mass (LVM) on echocardiography, predicts cardiovascular events in hypertensive patients as well as in the general population.1,2 LVH can occur through ventricular dilatation, wall thickening, or combinations thereof. To distinguish between these patterns of hypertrophy, LVH has been subclassified based on relative wall thickness (RWT; wall thickness/LV internal radius).3 If the ratio is high, the term concentric is applied; if not, the term eccentric hypertrophy is used. Recently, a new 4-group classification system derived by cardiac MRI reclassified participants with eccentric LVH with normal LV end-diastolic volume (EDV) into a subgroup with better LV function and, maybe, better outcome that is not captured with the conventional 2-group classification. 4 The new classification has not yet been related to clinical outcome in hypertensive patients. hypertensive patients with measurable LVM at baseline were randomized to a mean of 4.8 years of losartan-or atenololbased treatment. Patients with LVH (LVM/body surface area ≥116 and ≥96 g/m 2 in men and woman, respectively) were divided into 4 groups-concentric nondilated (increased M/EDV, normal EDV), eccentric dilated (increased EDV, normal M/EDV), concentric dilated (increased M/EDV and EDV), and eccentric nondilated (normal M/EDV and EDV)-and compared with patients with normal LVM. Time-varying LVH classes were tested for association with all-cause and cardiovascular mortality and a composite end point of myocardial infarction, stroke, heart failure, and cardiovascular death in multivariable Cox analyses. At baseline, the LVs were categorized as eccentric nondilated in 12%, eccentric dilated in 20%, concentric nondilated in 29%, concentric dilated in 14%, and normal LVM in 25%. Treatment changed the prevalence of 4 LVH groups to 23%, 4%, 5%, and 7%; 62% had normal LVM after 4 years. In time-varying Cox analyses, compared with normal LVM, those with eccentric dilated and both concentric nondilated and dilated LVH had increased risks of all-cause or cardiovascular mortality or the composite end point, whereas the eccentric nondilated group did not. Conclusions-Hypertensive patients with relatively mild LVH without either increased LV volume or concentricity have similar risk of all-cause mortality or cardiovascular events because hypertensive patients with normal LVM seem to be a low-risk group. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.(Circ Cardiovasc Imaging. 2014;7:422-429.)

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 81%

Section: Doppler Echocardiographymentioning

confidence: 99%

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Four-Group Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies a Low-Risk Subset of Eccentric Hypertrophy in Hypertensive Patients

Bang

Gerdts

Aurigemma

et al. 2014

Circ: Cardiovascular Imaging

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“…Dilated LV geometries as identified by this new classification have been shown to be strongly related to the presence of microalbuminuria in a large group of hypertensive patients. 21 Furthermore, when this classification was applied to high-risk hypertensive patients enrolled in the LIFE trial, it revealed significant differences in haemodynamic patterns and LV function 22 and enhanced prediction of cardiovascular prognosis. 10 In fact, both dilated and Metabolic syndrome and left ventricular dilatation E Ratto et al concentric patterns were found to be associated with increased incidence of cardiovascular events, whereas the eccentric nondilated group was not.…”

Section: Discussionmentioning

confidence: 98%

Metabolic syndrome is associated with left ventricular dilatation in primary hypertension

et al. 2015

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Metabolic syndrome (MS) has been shown to predict cardiovascular events in hypertension. Recently, a new four-group left ventricular (LV) hypertrophy classification based on both LV dilatation and concentricity was proposed. This classification has been shown to provide a more accurate prediction of cardiovascular events, suggesting that the presence of LV dilatation may add prognostic information. We investigated the relationship between MS and the new classification of LV geometry in patients with primary hypertension. A total of 372 untreated hypertensive patients were studied. Four different patterns of LV hypertrophy (eccentric nondilated, eccentric dilated, concentric nondilated and concentric dilated hypertrophy) were identified by echocardiography. A modified National Cholesterol Education Program definition for MS was used, with body mass index replacing waist circumference. The overall prevalence of MS and LV hypertrophy (LVH) was 29% and 61%, respectively. Patients with MS showed a higher prevalence of LVH (P=0.0281) and dilated LV geometries, namely eccentric dilated and concentric dilated hypertrophy (P=0.0075). Moreover, patients with MS showed higher LV end-diastolic volume (P=0.0005) and prevalence of increased LV end-diastolic volume (P=0.0068). The prevalence of LV chamber dilatation increased progressively with the number of components of MS (P=0.0191). Logistic regression analysis showed that the presence of MS entails a three times higher risk of having LV chamber dilatation even after adjusting for several potential confounding factors. MS is associated with LV dilatation in hypertension. These findings may, in part, explain the unfavourable prognosis observed in patients with MS.

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“…Recently, a new four-group left ventricular hypertrophy classification based on both left ventricular dilatation and concentricity was proposed [5]. When this classification is applied to patients with hypertension, that is the most common cause of left ventricular hypertrophy, the presence of left ventricular chamber dilatation allows us to identify various clinical phenotypes having specific haemodynamic patterns, left ventricular function [6] and cardiovascular prognosis [7].…”

Section: Introductionmentioning

confidence: 99%

Left ventricular dilatation and subclinical renal damage in primary hypertension

Ratto

Viazzi

Bonino

et al. 2015

Journal of Hypertension

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Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients

Abstract: The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.

Cited by 20 publications

References 41 publications

Four-Group Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies a Low-Risk Subset of Eccentric Hypertrophy in Hypertensive Patients

Four-Group Classification of Left Ventricular Hypertrophy Based on Ventricular Concentricity and Dilatation Identifies a Low-Risk Subset of Eccentric Hypertrophy in Hypertensive Patients

Metabolic syndrome is associated with left ventricular dilatation in primary hypertension

Left ventricular dilatation and subclinical renal damage in primary hypertension

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