Identifying Appropriate Height Exponents and the Impact on Diagnosis and Prognosis of Left Ventricular Hypertrophy: the REMODEL Study

Abstract

ABSTRACTBACKGROUNDLeft ventricular hypertrophy (LVH) is a strong predictor of adverse outcomes. Although normalizing LV mass (LVM) to height exponents reduced variability from body size, specific recommendations for height exponents are lacking due to a scarcity of normal cohorts to define appropriate height exponents. We aimed to demonstrate the diagnostic and prognostic implications of establishing height exponents specific to sex, ethnicity and imaging modality.METHODSNon-overweight/non-obese Asian healthy volunteers (n=416) were used to establish appropriate height exponents. The impact of these height exponents was examined in a separate cohort of Asians with hypertension (n=878). All individuals underwent standardized cardiovascular magnetic resonance. Primary outcome was a composite of acute coronary syndrome, heart failure hospitalization, stroke, and cardiovascular mortality.RESULTSThe height exponents for healthy females and males were 1.57 and 2.33, respectively. LVH was present in 27% of individuals with hypertension when indexed to body surface area (BSA) and 47% when indexed to sex-specific height exponents. Most individuals reclassified to LVH with height exponents were overweight or obese. There were 37 adverse events over 60 (37-73) months of follow-up. Regardless of indexing method, LVH was independently associated with increased adverse events (height exponent hazard ratio (HR): 2.8 [1.25-6.29], P=0.013;BSA HR: 5.43 [2.49-11.8], P<0.001).CONCLUSIONSReference ranges specific to ethnicity, sex and imaging modality are necessary to establish appropriate height exponents. Although utilising height exponents resulted in more LVH reclassification, this did not translate to a notable improvement in event prediction.Graphical AbstractIn this cardiovascular magnetic resonance study, the appropriate height exponents were 1.57 in Asian females and 2.33 in Asian males. Normalizing to height exponents increased the diagnosis of hypertensive left ventricular hypertrophy (LVH), predominantly in those who were overweight and obese. Regardless of the method of indexing, LVH was associated with adverse primary and secondary outcomes.