Key result
A new four-group classification of left ventricular hypertrophy identifies dilated subgroups with reduced left ventricular function compared to nondilated subgroups.
Why the study?
Does a new four-group LVH classification based on left ventricular dilatation and concentricity identify subgroups with reduced left ventricular function in hypertensive patients?
Observational (n=939)
Does a new four-group LVH classification based on left ventricular dilatation and concentricity identify subgroups with reduced left ventricular function in hypertensive patients?
A novel four-group classification of LVH based on LV dilatation and concentricity identifies hypertensive patients with reduced LV function better than traditional eccentric/concentric classifications.
Answers are grounded in this paper and cite their sources.
May refine hypertensive LVH phenotyping; hypothesis-generating and requires prospective outcome validation before practice change.
BACKGROUND: Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation [high left ventricular end-diastolic volume (EDV) index and concentricity (LVM/EDV)] in hypertensive patients. METHODS AND RESULTS: Nine hundred thirty-nine participants in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy had measurable LVM at enrolment. Patients with LVH (LVM/body surface area ≥116 g/m in men and ≥96 g/m in women) were divided into four groups; 'eccentric nondilated' (normal LVM/EDV and EDV), 'eccentric dilated' (increased EDV, normal LVM/EDV), 'concentric nondilated' (increased LVM/EDV with normal EDV), and 'concentric dilated' (increased LVM/EDV and EDV) and compared to patients with normal LVM. At baseline, 12% had eccentric nondilated, 20% eccentric dilated, 29% concentric nondilated, and 14% concentric dilated LVH, with normal LVM in 25%. Compared with the concentric nondilated LVH group, those with concentric dilated LVH had significantly lower pulse pressure/stroke index and ejection fraction; higher LVM index, stroke volume, cardiac output, left ventricular midwall shortening, left atrial volume and isovolumic relaxation time; and more had segmental wall motion abnormalities (all P < 0.05). Similar differences existed between patients with eccentric dilated and those with eccentric nondilated LVH (all P < 0.05). Compared with patients with normal LVM, the eccentric nondilated had higher LV stroke volume, pulse pressure/stroke index, Cornell voltage product and SBP, and lower heart rate and fewer were African-American (all P < 0.05). CONCLUSION: The new four-group classification of LVH identifies dilated subgroups with reduced left ventricular function among patients currently classified with eccentric or concentric LVH.
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Bang et al. (2013) conducted an observational in Hypertension (n=939). Four-group left ventricular hypertrophy classification (eccentric/concentric, dilated/nondilated) vs. Normal left ventricular mass and nondilated LVH groups was evaluated on Left ventricular systolic function parameters including ejection fraction and stroke volume (p=<0.05). A new four-group classification of left ventricular hypertrophy identifies dilated subgroups with reduced left ventricular function compared to nondilated subgroups.
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