Key result
Abnormal left ventricular geometry increased the risk of all-cause mortality (HR 1.64) compared to normal geometry in patients with no or nonobstructive coronary artery disease.
Why the study?
The combined prognostic value of no or nonobstructive CAD on CCTA and abnormal LV geometry on echocardiography has not been well elucidated.
Does abnormal left ventricular geometry increase the risk of all-cause mortality in patients with no or nonobstructive coronary artery disease?
Cohort (n=5,803)
Yes
Does abnormal left ventricular geometry increase the risk of all-cause mortality in patients with no or nonobstructive coronary artery disease?
In patients with no or nonobstructive coronary artery disease on CCTA, the presence of abnormal left ventricular geometry on echocardiography is an independent predictor of increased all-cause mortality.
Abnormal LV geometry was associated with higher mortality in nonobstructive CAD; extends prior observations but leaves open whether it improves risk stratification.
Background Coronary computed tomography angiography (CCTA) is widely used as a first-line noninvasive modality that frequently exhibits no or nonobstructive coronary artery disease (CAD) in clinical practice, along with abnormal left ventricular (LV) geometry on echocardiography. However, the combined prognostic value of these findings has not been well elucidated. Therefore, we aimed to evaluate the prognostic implications of abnormal LV geometry in individuals with no or nonobstructive CAD. Methods A total of 5806 subjects with no CAD or nonobstructive CAD (luminal narrowing < 50%) on CCTA were included in the study. The major exclusion criteria were structural heart disease and a history of myocardial infarction or coronary revascularization. Abnormal LV geometry on echocardiography was defined as LV mass index > 95 g/m 2 in women and > 115 g/m 2 in men, and/or relative wall thickness > 0.42. The primary outcome was all-cause mortality. Results A total of 5803 subjects without significant obstructive CAD (age, 56.6 ± 8.87 years; men, 3884 [66.9%]). Of them, 4045 (69.7%) subjects had normal LV geometry and 1758 (30.3%) had abnormal LV geometry respectively. During a mean follow-up of 6.2 ± 1.48 years, 84 (1.44%) subjects died in the study population. Of these, 56 subjects were from the normal LV geometry group (1.24%) and 28 were from the abnormal LV geometry group (2.32%). Subjects with abnormal LV geometry had significantly worse survival rates (log-rank, p < 0.001). After adjustment for confounding factors, abnormal LV geometry was an independent predictor of all-cause mortality (adjusted hazard ratio, 1.64; 95% confidence interval, 1.04–2.58; p = 0.034). Moreover, abnormal LV geometry was significantly worse in survival when classified as those with no CAD (log-rank, p = 0.024) and nonobstructive CAD (Log-rank, p < 0.001). Conclusions Abnormal LV geometry portends a worse prognosis in subjects with no or nonobstructive CAD. These findings suggest that LV geometry assessment can help improve the stratification of individuals with these CCTA findings.
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Choi et al. (2021) conducted a cohort in No or nonobstructive coronary artery disease (n=5,803). Abnormal left ventricular geometry vs. Normal left ventricular geometry was evaluated on All-cause mortality (HR 1.64, 95% CI 1.04-2.58, p=0.034). Abnormal left ventricular geometry increased the risk of all-cause mortality (HR 1.64) compared to normal geometry in patients with no or nonobstructive coronary artery disease.
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