Abstract 3193: The Progression From Concentric Left Ventricular Hypertrophy to Reduced Left Ventricular Ejection Fraction is Not Common After 7 Years
Introduction Whether concentric left ventricular (LV) hypertrophy (LVH) is a common precursor to depressed LV ejection fraction (EF) in humans is uncertain. We previously demonstrated that this transition occurred in 18% of subjects after follow-up of ~4 years (Am J Cardiol, 2004:93:234 –237). We hypothesized that this transition would remain infrequent after longer term follow-up.
Methods We performed a follow-up analysis of the previously described single-center cohort. From 1992 through 1994, 566 patients at our institution had an echocardiogram with LVH (posterior or septal wall thickness ≥1.3 cm or concentric LVH noted), normal LVEF, and no significant valvular disease. Of these, 219 subjects have had a follow-up echocardiogram for clinical indications. LVEF was assessed qualitatively as normal, mildly, moderately, or severely reduced. The primary outcome variable was the development of a depressed LVEF (mildly, moderately, or severely reduced). Clinical characteristics were extracted by chart review and compared between those who did or did not reach the outcome.
Results: Baseline and follow-up characteristics are shown (Table⇓). The population was predominantly middle-aged, African-American, female, and hypertensive. After a median (25th, 75th) follow-up of 7.4 (4, 11) years, 45 (21%) subjects developed a low LVEF: 19 mildly, 19 moderately, and 7 severely depressed. History of coronary artery disease and LV diastolic dimension at baseline, and interval myocardial infarction (MI) were associated with development of low LVEF (Table⇓). In multivariable analyses, LV diastolic dimension at baseline [odds ratio (95% confidence intervals)] 3.1 (1.6, 6.2) and interval MI 12 (4.3, 34) remained associated with the outcome.
Conclusions: In subjects with concentric LVH and a normal EF, relatively few (21%) develop a reduced LVEF at 7 years of follow-up. Interval MI is a common mediator of this transition.