Why the study?
The predictive value for mortality of LVH defined by Chinese thresholds versus international guidelines, and the optimal LVM indexation method in Chinese hypertensive individuals, were unclear.
Does left ventricular hypertrophy defined by Chinese thresholds better predict mortality compared to international guideline thresholds in Chinese hypertensive patients?
Does left ventricular hypertrophy defined by Chinese thresholds better predict mortality compared to international guideline thresholds in Chinese hypertensive patients?
In Chinese hypertensive patients, race-specific thresholds for left ventricular hypertrophy (LVM/BSA and LVM/Height^1.7) offer better mortality risk stratification than international guideline thresholds.
May improve mortality prediction with Chinese-specific LVH thresholds in hypertensives; leaves open prospective confirmation before practice change.
To compare the predictive value of mortality between left ventricular hypertrophy (LVH) defined by Chinese thresholds and defined by international guidelines in hypertension individuals and investigate better indexation methods for LVH in Chinese population. We included 2454 community hypertensive patients with Left ventricular mass (LVM) and relative wall thickness. LVM was indexed to body surface area (BSA), height² ⁷ and height ¹ ⁷ . The outcomes were all-cause and cardiovascular mortality. Cox proportional hazards models were used to explore the association between LVH and the outcomes. C-statistics and time-dependent receiver operating characteristic curve (ROC) was used to evaluate the value of those indicators. During a median follow-up of 49 months (interquartile range 2-54 months), 174 participants (7.1%) died from any cause (n = 174), with 71 died of cardiovascular disease. LVM/BSA defined by the Chinese thresholds was significantly associated with cardiovascular mortality (HR: 1.63; 95%CI: 1.00-2.64). LVM/BSA was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.56; 95%CI: 1.14-2.14) and using Guideline thresholds (HR: 1.52; 95%CI: 1.08-2.15). LVM/Height1.7 was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.60; 95%CI: 1.17-2.20) and using Guideline thresholds (HR: 1.54; 95%CI: 1.04-2.27). LVM/Height2.7 was not significantly associated with all-cause mortality. C-statistics indicated that LVM/BSA and LVM/Height1.7 by Chinese thresholds had better predictive ability for mortality. Time-ROC indicated that only LVM/Height1.7 defined by Chinese threshold had incremental value for predicting mortality. We found that in community hypertensive populations, race-specific thresholds should be used to classify LV hypertrophy related to mortality risk stratification. LVM/BSA and LVM/Height1.7 are acceptable normalization method in Chinese hypertension.
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Zhou et al. (2023) studied this question.
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