Key result
Septal left ventricular hypertrophy strongly increased the risk of fatal cardiovascular disease compared to normal myocardium mass (RR 6.0; 95% CI 2.55-14.18; P<0.001).
Why the study?
Concentric hypertrophy is known to have the highest impact on cardiovascular risk among LVH geometric patterns, but less is known about the septal hypertrophy pattern's prognostic impact.
Do specific geometric patterns of left ventricular hypertrophy predict cardiovascular incidence and mortality in a general population?
Cohort (n=2,006)
No
Do specific geometric patterns of left ventricular hypertrophy predict cardiovascular incidence and mortality in a general population?
Relative Risk: 6 (95% CI 2.55–14.18)
p-value: p=<0.001
Disproportionate septal hypertrophy is a powerful, independent predictor of fatal cardiovascular disease in the general population, carrying a higher risk than concentric hypertrophy when adjusted for myocardial mass.
Septal hypertrophy may independently elevate fatal CVD risk; leaves open whether geometry patterns warrant targeted screening beyond mass in general populations.
The left ventricular hypertrophy (LVH) is an established predictor of fatal and non-fatal cardiovascular outcomes. Concentric hypertrophy was shown to have the highest impact on CVD risk among geometric patterns of LVH, much less is known about septal hypertrophy pattern. Purpose: To assess the impact of four geometric patterns of LVH on CVD incidence and mortality in a general population. Methods: Random population sample (n = 2006, men and women aged 25–64 at baseline) was examined echocardiographically in Novosibirsk (Russia). The cohort was followed-up during on the average 12.2 year. We distinguished four types of LVH: eccentric-nondilated (END), eccentric-dilated (ED), concentric (C), and disproportionate septal (DS) hypertrophy. For end points we registered acute myocardial infarction (MI), fatal coronary heart disease (CHD), cardiovascular deaths (CVD) and deaths from all causes. Results: The LVH was defined according to population-specific reference value for myocardium mass (MM) index (MMI): 124 g/sq m for men and 100 g/sq m for women (90% cut-off point of MMI distribution in apparently healthy group). Totally 220 outcomes occurred during follow-up in studied cohort. The multivariate adjusted relative risk (RR) of incident MI, fatal MI, CVD death, and all-cause death in subjects with LVH was elevated approximately 1.6–2 times compared to those with normal MMI. The relative risk for fatal CVD in concentric LVH comprised RR = 3.4 (95%CI 1.48–7.99, p = 0.004), and was attenuated to borderline when adjusted for MM. Septal hypertrophy increased the risk of fatal CVD much strongly: RR = 6.0 (95%CI 2.55–14.18, p < 0.001), and this association remained significant after further controlling for MM. ED hypertrophy increased only the risk of all-cause death among men (RR = 1.6, p = 0.05). Conclusion: Among LVH geometric types, concentric and septal hypertrophy are the powerful predictors of CVD risk in general population. The excess risk of fatal CVD in concentric LVH is largely explained by myocardium mass. Septal hypertrophy strongly increased the risk of fatal CVD independently of myocardium mass.
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Ryabikov et al. (2010) conducted a cohort in Left ventricular hypertrophy (n=2,006). Septal left ventricular hypertrophy vs. Normal myocardium mass index was evaluated on Fatal cardiovascular disease (RR 6.0, 95% CI 2.55-14.18, p=<0.001). Septal left ventricular hypertrophy strongly increased the risk of fatal cardiovascular disease compared to normal myocardium mass (RR 6.0; 95% CI 2.55-14.18; P<0.001).
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