Abstract 12228: Echocardiographic Detection of Left Ventricular Hypertrophy in the Elderly: Which Indexing Method is the Best Predictor of Mortality?
Background: Left ventricular hypertrophy (LVH) is a powerful independent risk factor predicting subsequent cardiovascular morbidity and mortality in the elderly population and is clinically best determined by echocardiography as left ventricular mass (LVM) indexed to body size [either body surface area (BSA) or height 2.7(Ht2.7)]. However, considerable controversy exists regarding which of these two methods is superior for determination of LVH and its association with mortality.
Patients and Methods: We evaluated 16,901 elderly patients (age ≥ 70 years) with preserved ejection fraction to determine the impact of LVM indexed to either BSA (LVH=LVM index >96 g/m2 in women and 116g/m2 in men) or Ht2.7 (LVH=LVM index >51g/m2.7) on prevalence of LVH and subsequent mortality during an average follow-up of 1.7 ±1.0 years.
Results: Deceased patients (n=2,404) had significantly higher LVM (174.1±66.8g vs. 169.4 ± 63.2g, p<0.0001) and prevalence of LVH [by LVM/BSA (26.4% vs. 21.0%, p<0.0001) or by LMV/ Ht2.7 (26.0% vs. 22.1%, p<0.0001)] than survivors (n=14,497). Both LVM indices were significantly correlated (r=0.80, p<0.0001) and were concordant in determining the presence or absence of LVH in 93% of patients. In the 7% (n=1,189) of patients where categorical LVH was discordant between the two indexing methods, LVH determined by LVM indexed to BSA predicted an increase in mortality compared to patients without LVH (20.0% vs. 13.4%, p <0.0001) whereas LVH determined by LVM indexed to Ht2.7 did not (13.8 vs. 13.4, p=NS) (Figure).
Conclusions: Although both echocardiographic LVH indices predicted higher mortality, classification of LVH using LVM indexed to BSA is superior to LVM indexed to Ht2.7 in predicting subsequent mortality in elderly patients.
- © 2011 by American Heart Association, Inc.