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Background: In the general population, a 4-tiered classification of left ventricular hypertrophy (LVH), which accounts for the presence of left ventricular (LV) dilation in addition to increased relative wall thickness (RWT), provided additional prognostic information beyond the conventional 2-tiered classification (concentric vs. eccentric LVH). Whether this 4-tiered classification provides prognostic information in subjects with heart failure with preserved ejection fraction (HFpEF) is unknown.
Methods: LVH (increased LV mass indexed to BSA) was classified as indeterminate (RWT not increased and LV not dilated), dilated (RWT not increased and LV dilated), thick (increased RWT and LV not dilated), or both (increased RWT and LV dilated), where LV dilation was defined by increased LV end diastolic volume indexed to BSA. This 4-tiered classification for LVH was applied to 877 participants with baseline core lab echocardiographic data in the TOPCAT trial. Univariable and multivariable Cox proportional hazard models were used to determine the relationship between LVH patterns and long-term clinical outcomes.
Results: In the study cohort, 53% had no LVH, 6% had indeterminate, 3% had dilated hypertrophy, 34% had thick hypertrophy, and 4% had both thick and dilated hypertrophy. After median follow up of 3.4 years, in unadjusted analysis, thick hypertrophy versus no LVH was associated with an increased risk of death and the composite of death and heart failure hospitalization [HR 1.6 95% CI (1.1-2.2) p=0.01 and HR 1.5 95% CI (1.2 -2.0) p=0.001, respectively]. In adjusted analyses, thick hypertrophy versus no LVH remained associated with death and the composite of death and heart failure hospitalization [HR 1.5 95% CI (1.1-2.1) p=0.01 and HR 1.5 95% CI (1.2 -2.0) p=0.001, respectively]. Indeterminate, dilated, and both thick and dilated hypertrophy were not associated with adverse outcomes.
Conclusions: In HFpEF, thick hypertrophy was the predominate form of LVH, and was associated with an increased risk of death and heart failure hospitalization. Relatively few subjects had LV dilation. These findings support the pathological importance of concentric ventricular remodeling in HFpEF.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-274
- 2017 American College of Cardiology Foundation