Abstract 16291: Impact of Left Ventricular Hypertrophy Regression on Cardiovascular Outcomes. A Meta-Analysis
Introduction: Several clinical studies showed that left ventricular hypertrophy (LVH) regression is associated with a reduced risk of cardiovascular events. However, to date there is no meta-analysis putting in direct relationship the extent of LVH changes and cardiovascular outcomes. We performed a metaregression analysis assessing and quantifying the relationship between LVH regression and a composite cardiovascular outcome.
Methods: MEDLINE and the Cochrane Database were searched for articles published until May 2010. All randomized trials assessing LVH at baseline, at end of follow-up and reporting clinical end points were included. Two reviewers independently retrieved, reviewed and extracted data. Discrepancies were resolved by consensus. A weighted random-effect meta-regression analysis was performed to test the relationship between LVH changes and outcomes. Odds Ratios (OR) and 95% Confidence Intervals (CI) were calculated with a fixed-effects or random effects model. The influence of baseline patients' characteristics, LVH at baseline, follow up was also explored.
Results: Six trials were included for a total of 2144 patients. By pooling all trials included in the meta-analysis, the risk for the composite outcome was significantly reduced by treatment vs control (OR 0.59; 95% CI 0.44 to 0.78; comparison p<0.0001; heterogeneity p=0.4). This risk reduction was associated with a decrease in left ventricular mass with a borderline significance (Tau=2.3 P=0.07). In particular, for a 5% decrease in left ventricular mass there was a substantial decrease by 31% of composite outcome risk. Systolic and diastolic blood pressure influenced the association between the change in left ventricular mass with a trend of borderline significance However, the other potential effect modifiers considered (age, BMI, women, year of publication, follow up length, systolic and diastolic blood pressure baseline) did not significantly influence the results.
Conclusion: As also demonstrated by single randomized clinical trials, in a pooled analysis LVH regression predict CV risk reduction. Therefore, our results suggest that its role in tracking cardiovascular risk modification is valid.
- © 2010 by American Heart Association, Inc.