Document Detail


Four-group classification of left ventricular hypertrophy based on ventricular concentricity and dilatation identifies a low-risk subset of eccentric hypertrophy in hypertensive patients.
MedLine Citation:
PMID:  24723582     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular hypertrophy (LVH; high LV mass [LVM]) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of subsequent adverse events in a new 4-group LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV](2/3)) in hypertensive patients.
METHODS AND RESULTS: In the Losartan Intervention for Endpoint Reduction (LIFE) echocardiography substudy, 939 hypertensive patients with measurable LVM at baseline were randomized to a mean of 4.8 years of losartan- or atenolol-based 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.
Authors:
Casper N Bang; Eva Gerdts; Gerard P Aurigemma; Kurt Boman; Giovanni de Simone; Björn Dahlöf; Lars Køber; Kristian Wachtell; Richard B Devereux
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2014-04-10
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  7     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-05-21     Completed Date:  2014-07-11     Revised Date:  2014-11-13    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  422-9     Citation Subset:  IM    
Copyright Information:
© 2014 American Heart Association, Inc.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00338260
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Analysis of Variance
Antihypertensive Agents / therapeutic use
Atenolol / therapeutic use
Cause of Death
Death
Echocardiography, Doppler / methods
Female
Follow-Up Studies
Heart Failure / complications,  pathology
Heart Ventricles / pathology*,  ultrasonography*
Humans
Hypertension / complications*,  drug therapy,  pathology
Hypertrophy, Left Ventricular / complications*,  pathology,  ultrasonography*
Losartan / therapeutic use
Male
Middle Aged
Myocardial Infarction / complications,  pathology
Organ Size
Proportional Hazards Models
Stroke / complications,  pathology
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 50VV3VW0TI/Atenolol; JMS50MPO89/Losartan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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