Author + information
- Robert J.H. Miller,
- Ahmed Abdi Ali,
- Yoko Mikami,
- Bobby Heydari,
- Andrew Howarth,
- Carmen Lydell,
- Stephen Wilton and
- James White
Background: Left ventricular hypertrophy (LVH) is a well-established risk factor for the development of cardiovascular complications. However, the pattern of LVH based on LV mass, LV dilation, and concentricity may have incremental prognostic implications. We investigated associations between LVH patterns determined by cardiovascular Magnetic Resonance (CMR) imaging and all-cause mortality.
Methods: 3754 patients (age 59.3±13.1 years) undergoing CMR and invasive coronary angiography (mean interval 1.0±1.5 months) were studied. LV mass and volumes were determined from cine images and indexed to body surface area. Patients were categorized as having normal LV mass, concentric remodelling, eccentric LVH, or concentric LVH based on relative wall thickness and increased LVMI according to published criteria.
Results: In our cohort the mean LVEF was 45.7 ± 16.3, mean LVEDV was 191 ± 78 and mean LVMI was 69.5 ± 23.4. Over a median follow-up of 44.9 months a total of 315 patients died. Eccentric LVH (884 patients, unadjusted HR 2.66, 95% CI 1.80 to 3.91, p<0.01) and concentric LVH (204 patients, unadjusted HR 1.94, 95% CI 1.51 – 2.49, p<0.01) were associated with all-cause mortality in univariate analyses, while concentric remodelling was not (141 patients). After correcting for relevant baseline clinical variables including medical co-morbidities, extent of coronary artery disease and LV ejection fraction, concentric LVH continued to be associated with increased all-cause mortality (adjusted HR 2.99, 95% CI 2.02 – 4.43, p<0.01), while eccentric LVH and concentric remodelling were not.
Conclusions: In this cohort of patients being investigated by diagnostic coronary angiography and CMR, LVMI was strongly associated with mortality. However, pattern of LVH was identified to be the most important contributor to mortality risk with concentric LVH associated with worse outcomes compared to either eccentric LVH or concentric remodelling. This provides strong justification for adherence to societal recommendations to report LVH pattern in addition to LV mass in routine diagnostic reporting.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Non Invasive Imaging: MR Characterization and Function
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1118-208
- 2017 American College of Cardiology Foundation