Abstract
AbstractThe clinical and biochemical profile of differing LVH phenotypes and its effect on long term outcomes is ill-defined. The study investigated the differences in risk profiles and prognostic effect of concentric (CH) and eccentric hypertrophy (EH) on long-term adverse outcomes in a contemporary, ethnically diverse cohort. We analyzed follow-up data over 15 years from the Multi-Ethnic Study of Atherosclerosis study, an ongoing multicenter, prospective population-based study in the United States that enrolled 6,814 participants with subclinical cardiovascular disease between 2000 and 2002. 4,979 participants with left ventricular mass and wall thickness, derived from cardiac MRI at baseline enrollment were included. Descriptive statistics, Kaplan-Meier curves, and regression models were applied. Independent variables associated with CH were Black and Hispanic race/ethnicity, systolic blood pressure, and metabolic syndrome. Independent variables associated with EH were systolic blood pressure, urine creatinine, whereas serum creatinine had an inverse association. The primary endpoint of all-cause death (n=1,137, 22.8%) occurred in 21.7%, 47.4%, and 56.6% of participants with no, concentric, or eccentric hypertrophy, respectively (p<0.001). Age (HR per year = 1.10 [1.09, 1.11], p<0.001), male gender (HR=1.48 [1.29, 1.69], p<0.001), Black race (HR=1.17 [1.005,1.36], p=0.04), fasting glucose (HR=1.005 [1.003, 1.007], p<0.001), baseline creatinine (HR per mg/dL = 1.29 [1.15-1.46], p<0.001), LVEF (HR per 1% = 0.98 [0.98, 0.99], p=0.005), IL-6 (HR per pg/mL = 1.17 [1.12, 1.22], p<0.001), concentric hypertrophy (HR=1.84 [1.41-2.41], p<0.001), and eccentric hypertrophy (HR=2.58 [1.77-3.76], p<0.001) were significant predictors of all-cause mortality. We conclude that CH and EH are two distinct clinical phenotypes of left ventricular hypertrophy with differing gender and racial predisposition, both associated with worse long-term adverse outcomes.
Publisher
Cold Spring Harbor Laboratory