TY - JOUR
T1 - The natural history of left ventricular geometry in the community
T2 - Clinical correlates and prognostic significance of change in LV geometric pattern
AU - Lieb, Wolfgang
AU - Gona, Philimon
AU - Larson, Martin G.
AU - Aragam, Jayashri
AU - Zile, Michael R.
AU - Cheng, Susan
AU - Benjamin, Emelia J.
AU - Vasan, Ramachandran S.
N1 - Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study (contract no. N01-HC-25195) and grants R01HL080124 (Dr. Vasan) and K99HL10762 (Dr. Cheng) and 6R01-NS 17950. Dr. Cheng was in part supported by a grant from the Ellison Foundation . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2014 by the American College of Cardiology Foundation.
PY - 2014
Y1 - 2014
N2 - Objectives: This study sought to evaluate pattern and clinical correlates of change in left ventricular (LV) geometry over a 4-year period in the community; it also assessed whether the pattern of change in LV geometry over 4 years predicts incident cardiovascular disease (CVD), including myocardial infarction, heart failure, and cardiovascular death, during an additional subsequent follow-up period. Background: It is unclear how LV geometric patterns change over time and whether changes in LV geometry have prognostic significance. Methods: This study evaluated 4,492 observations (2,604 unique Framingham Heart Study participants attending consecutive examinations) to categorize LV geometry at baseline and after 4 years. Four groups were defined on the basis of the sex-specific distributions of left ventricular mass (LVM) and relative wall thickness (RWT) (normal: LVM and RWT <80th percentile; concentric remodeling: LVM <80th percentile but RWT ≥80th percentile; eccentric hypertrophy: LVM ≥80th percentile but RWT <80th percentile; and concentric hypertrophy: LVM and RWT ≥80th percentile). Results: At baseline, 2,874 of 4,492 observations (64%) had normal LVM and RWT. Participants with normal geometry or concentric remodeling progressed infrequently (4% to 8%) to eccentric or concentric hypertrophy. Change from eccentric to concentric hypertrophy was uncommon (8%). Among participants with concentric hypertrophy, 19% developed eccentric hypertrophy within the 4-year period. Among participants with abnormal LV geometry at baseline, a significant proportion (29% to 53%) reverted to normal geometry within 4 years. Higher blood pressure, greater body mass index (BMI), advancing age, and male sex were key correlates of developing an abnormal geometry. Development of an abnormal LV geometric pattern over 4 years was associated with increased CVD risk (140 events) during a subsequent median follow-up of 12 years (adjusted-hazards ratio: 1.59; 95% confidence interval: 1.04 to 2.43). Conclusions: The longitudinal observations in the community suggest that dynamic changes in LV geometric pattern over time are common. Higher blood pressure and greater BMI are modifiable factors associated with the development of abnormal LV geometry, and such progression portends an adverse prognosis.
AB - Objectives: This study sought to evaluate pattern and clinical correlates of change in left ventricular (LV) geometry over a 4-year period in the community; it also assessed whether the pattern of change in LV geometry over 4 years predicts incident cardiovascular disease (CVD), including myocardial infarction, heart failure, and cardiovascular death, during an additional subsequent follow-up period. Background: It is unclear how LV geometric patterns change over time and whether changes in LV geometry have prognostic significance. Methods: This study evaluated 4,492 observations (2,604 unique Framingham Heart Study participants attending consecutive examinations) to categorize LV geometry at baseline and after 4 years. Four groups were defined on the basis of the sex-specific distributions of left ventricular mass (LVM) and relative wall thickness (RWT) (normal: LVM and RWT <80th percentile; concentric remodeling: LVM <80th percentile but RWT ≥80th percentile; eccentric hypertrophy: LVM ≥80th percentile but RWT <80th percentile; and concentric hypertrophy: LVM and RWT ≥80th percentile). Results: At baseline, 2,874 of 4,492 observations (64%) had normal LVM and RWT. Participants with normal geometry or concentric remodeling progressed infrequently (4% to 8%) to eccentric or concentric hypertrophy. Change from eccentric to concentric hypertrophy was uncommon (8%). Among participants with concentric hypertrophy, 19% developed eccentric hypertrophy within the 4-year period. Among participants with abnormal LV geometry at baseline, a significant proportion (29% to 53%) reverted to normal geometry within 4 years. Higher blood pressure, greater body mass index (BMI), advancing age, and male sex were key correlates of developing an abnormal geometry. Development of an abnormal LV geometric pattern over 4 years was associated with increased CVD risk (140 events) during a subsequent median follow-up of 12 years (adjusted-hazards ratio: 1.59; 95% confidence interval: 1.04 to 2.43). Conclusions: The longitudinal observations in the community suggest that dynamic changes in LV geometric pattern over time are common. Higher blood pressure and greater BMI are modifiable factors associated with the development of abnormal LV geometry, and such progression portends an adverse prognosis.
KW - Cardiovascular disease
KW - Change over time
KW - Echocardiography
KW - Epidemiology
KW - Heart failure
KW - LV geometry
KW - Remodeling
UR - http://www.scopus.com/inward/record.url?scp=84922591344&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84922591344&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2014.05.008
DO - 10.1016/j.jcmg.2014.05.008
M3 - Article
C2 - 25129518
AN - SCOPUS:84922591344
SN - 1936-878X
VL - 7
SP - 870
EP - 878
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 9
ER -