Abstract 4157: Do Left Ventricular Hypertrophy and Systolic Dysfunction Represent Sequential Steps in the Pathway to Heart Failure (The Strong Heart Study)?
Background: Since work in the 1960s by Meerson and others it has been widely accepted that adaptive left ventricular hypertrophy (LVH) and systolic LV dysfunction (LVD) are sequential steps in the pathway to congestive heart failure (CHF) but few data exist to support this hypothesis in unselected adults.
Methods: Members of the population-based Strong Heart Study (SHS) cohort who underwent echocardiography at the 2nd and 4th SHS exams a mean of 7.8 years apart and were free of overt cardiovascular disease (CVD) or CHF at baseline constitute the study population. LVH was identified by LV mass/height2.7 >47 g/m2.7 in women or >50 in men; new-onset CHF during mean follow-up of 8.3 years after the 2nd SHS exam was adjudicated by physician endpoint committees.
Results: At baseline, 82/415 participants (20%) had LVH, with mean EF slightly lower in the normal range than those without LVH (mean=62 vs 64%). New onset CHF developed in more participants with than without LVH (14.5 vs. 4.5%, OR 3.1 [95% CI 1.6 – 8.1] p=0.002). Among participants who developed CHF, mean LV EF fell from 63% at baseline to 51% at follow-up (p=0.002) in those without LVH at baseline but did not change (mean =60 vs. 58%, NS) in those with LVH at baseline.
Conclusions: Among longitudinally-followed members of a population-based sample, LVH at baseline strongly predicted incident CHF. However, serial echocardiograms in adults who developed CHF do not document the decline in LV EF in patients with baseline LVH predicted by the Meerson hypothesis of orderly steps from compensated LVH to LVH with systolic dysfunction to overt CHF.