Abstract 12734: A New 4-group Classification of Left Ventricular Hypertrophy Based on left Ventricular Geometry Located a New High-risk Group within Eccentric Hypertrophy in Hypertensive Patients - A LIFE Study

Abstract

Background: Left ventricular hypertrophy (LVH) is traditionally classified as concentric or eccentric, based on LV relative wall thickness (RWT, wall thickness/chamber radius). We evaluated a 4-group LVH classification based on LV concentricity (mass/end-diastolic volume [M/EDV]^(2/3)) and indexed LV EDV in hypertensive patients.

Methods: In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, hypertensive patients with LVH on a screening ECG were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. Echocardiography was performed in 939 at baseline and yearly thereafter. The patients with LVH (LVmass/height^2.7 ≥46.7 g/m^2.7 in woman ≥49.2 g/m^2.7 in men) were divided into 4 groups (Figure); “indeterminate” (normal M/EDV and EDV), “dilated” (increased EDV, normal M/EDV), “thick” (increased M/EDV with normal EDV), “thick and dilated” (increased M/EDV and EDV) and compared to non-LVH patients. The 4 LVH groups were considered as time-varying covariates in Cox models for all-cause mortality and a composite endpoint (CEP) of cardiovascular death, stroke, heart failure and myocardial infarction.

Results: At baseline, the 939 patients were categorized as “indeterminate” in 13%, ”dilated” in 25%, “thick” in 25%, “thick and dilated” in 19% and non-LVH in 17%. Treatment reduced prevalences of the 4 LVH groups to 10%, 35%, 5%, 5%, and 45% with no LVH after 4 years. In time-varying Cox analyses, the “indeterminate” LVH group had no increased risk of all-cause mortality, while “dilated”, “thick” and “both think and dilated” did (Figure). With the traditional method the eccentric LVH was not associated with increased risk of all-cause mortality, however concentric LVH was (Figure).

Conclusions: The new 4-tiered classification method of hypertrophy located a subgroup of eccentric hypertrophy with increased risk of all-cause mortality, while the traditional classification method did not.