The Natural History of Left Ventricular Geometry in the Community Clinical Correlates and Prognostic Significance of Change in LV Geometric Pattern

JACC-CARDIOVASCULAR IMAGING

卷:7

Article

Lieb, Wolfgang^1,2  Gona, Philimon^1,3  Larson, Martin G.^1,4  Aragam, Jayashri^5,6  Zile, Michael R.^7,8  Cheng, Susan⁹  Benjamin, Emelia J.^1,10,11  Vasan, Ramachandran S.^1,10,11 

[1] Framingham Heart Dis Epidemiol Study, Framingham, MA 01702 USA

[2] Univ Kiel, Inst Epidemiol, Kiel, Germany

[3] Univ Massachusetts, Boston, MA 02125 USA

[4] Boston Univ, Dept Math & Stat, Boston, MA 02215 USA

[5] Boston Vet Affairs Hlth Care Syst, West Roxbury, MA USA

[6] Harvard Univ, Sch Med, Boston, MA USA

[7] Med Univ S Carolina, Charleston, SC 29425 USA

[8] Dept Vet Affairs Med, Charleston, SC USA

[9] Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA

[10] Boston Univ, Sch Med, Whitaker Cardiovasc Inst, Prevent Med & Cardiol Sect, Boston, MA 02118 USA

[11] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

关键词: cardiovascular disease;    change over time;    echocardiography;    epidemiology;    heart failure;    LV geometry;    remodeling;   

DOI  :  10.1016/j.jcmg.2014.05.008

来源: Elsevier

【 摘 要 】

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. (C) 2014 by the American College of Cardiology Foundation.

【 授权许可】

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