Global thickness for accurate and precise evaluation of post-intervention remodelling in left ventricular hypertrophy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Left ventricular hypertrophy across aortic stenosis, hypertension, athletic remodeling, and aortic regurgitation alongside healthy volunteers (n=4727). Intervention: Global average left ventricular end-diastolic wall thickness (GT) assessment by CMR vs. Left ventricular mass-to-end-diastolic volume ratio (LVM/EDV). Primary outcome: Post-intervention change in global average left ventricular end-diastolic wall thickness (GT) and correlation with EDV in health (R2 0.16 in health; GT changed in all 4 intervention cohorts (AS -1.75 mm, HTN -0.66 mm, athletes -0.29 mm, AR +0.50 mm), p=≤0.02).

Lynn Khor; Hunain Shiwani; George D. Thornton; Jonathan Bennett; Nikoo Aziminia; Abhishek M. Shetye; Constantin-Cristian Topriceanu; Gabriella Captur; Rhodri Huw Davies; J C Moon; Peter Swoboda; Calvin Chin; Thomas Alexander Treibel; Rebecca Kozor; Martin Ugander

doi:10.64898/2026.11.01.26367004

November 2, 2026Open Access

Global thickness for accurate and precise evaluation of post-intervention remodelling in left ventricular hypertrophy

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Key result

CMR-derived global wall thickness tracks post-intervention LV remodeling without confounding by end-diastolic volume.

R2<0.02 vs R2>0.16 in health; GT changed in all 4 intervention cohorts (AS -1.75 mm, HTN -0.66 mm, athletes -0.29 mm, AR +0.50 mm)
P≤0.02
n=4,727

Why the study?

Cardiovascular interventions may impact both left ventricular mass and end-diastolic volume, making the net effect on wall thickness difficult to accurately evaluate. Whether global average left ventricular end-diastolic wall thickness can serve as an ideal measure of post-intervention change in left ventricular hypertrophy required evaluation.

Does global average left ventricular end-diastolic wall thickness (GT) by cardiovascular magnetic resonance more accurately and consistently detect post-intervention cardiac remodelling in left ventricular hypertrophy compared to the left ventricular mass-to-volume ratio (LVM/EDV)?

Key Points

To determine whether global average left ventricular end-diastolic wall thickness remains independent of end-diastolic volume in health and serves as an accurate measure of remodelling following intervention in left ventricular hypertrophy.
Calculated global average left ventricular end-diastolic wall thickness (GT) using cardiovascular magnetic resonance and evaluated its correlation with end-diastolic volume (EDV) in 4,461 healthy volunteers (mean±SD age 59±10 years, 50% female).
Assessed post-intervention changes in GT compared to mass-to-volume ratio (LVM/EDV) across four cohorts: aortic stenosis undergoing valve replacement (n=102), hypertension starting antihypertensive therapy (n=78), athletes during forced detraining (n=28), and aortic regurgitation undergoing valve replacement (n=58).
In healthy volunteers, EDV correlated with LVM/EDV but showed negligible correlation with GT (R2>0.16 vs R2<0.02, p<0.001 for both sexes).
GT changed significantly following intervention across all conditions (p≤0.02 for all), showing mean±SEM changes of -1.75±0.13 mm in aortic stenosis, -0.66±0.08 mm in hypertension, -0.29±0.09 mm in athletes, and +0.50±0.11 mm in aortic regurgitation (p≤0.02 for all comparisons), whereas LVM/EDV did not consistently change.
In the hypertension cohort, sacubitril/valsartan induced a significantly greater reduction in GT than valsartan alone (-0.86±0.12 vs -0.46±0.08 mm, p=0.007), whereas the difference in LVM/EDV reduction was not statistically significant (-0.08±0.02 vs -0.04±0.01 g/mL, p=0.06).

Study Design

Type

Cohort (n=4,727)

Multicenter

Yes

Structured PICO

Does global average left ventricular end-diastolic wall thickness (GT) by cardiovascular magnetic resonance more accurately and consistently detect post-intervention cardiac remodelling in left ventricular hypertrophy compared to the left ventricular mass-to-volume ratio (LVM/EDV)?

P

Population

4,727 participants comprising 4,461 healthy volunteers (mean age 59 years, 50% female) and 266 patients undergoing interventions for aortic stenosis (n=102), hypertension (n=78), athletic detraining (n=28), or aortic regurgitation (n=58) evaluated with cardiovascular magnetic resonance.

E

Exposure

Evaluation of global average left ventricular end-diastolic wall thickness (GT, calculated as 0.05 + 1.60 LVM[g]^0.84 EDV[ml]^-0.49 by cardiovascular magnetic resonance) before and after condition-specific interventions: aortic valve replacement for severe aortic stenosis or severe aortic regurgitation, antihypertensive medication (sacubitril/valsartan or valsartan alone for 1 year) for essential hypertension, and 1 month of forced detraining for athletes.

C

Comparator

Left ventricular mass to end-diastolic volume ratio (LVM/EDV, g/mL) and concentricity0.67 (LVM/EDV^(2/3)) measured by cardiovascular magnetic resonance; additionally, comparison between sacubitril/valsartan and valsartan alone within the hypertension cohort.

O

Outcome

Correlation of GT vs. LVM/EDV with EDV in healthy volunteers, and pre- to post-intervention changes in GT, LVM/EDV, LVM, and EDV across the four interventional cohorts.surrogate

Main Result

Effect estimate: R2<0.02 vs R2>0.16 in health; GT changed in all 4 intervention cohorts (AS -1.75 mm, HTN -0.66 mm, athletes -0.29 mm, AR +0.50 mm)

p-value: p=≤0.02

Limitations

Retrospective study of pre-existing CMR measures from previously published cohorts
Mixture of manual delineations and automated artificial intelligence-based delineations from different CMR laboratories
Lack of prospective clinical outcome correlation for changes in GT versus other CMR indices

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Implication

Global average left ventricular end-diastolic wall thickness (GT) measured by CMR is independent of ventricular volume in health and outperforms the traditional mass-to-volume ratio (LVM/EDV) in detecting and differentiating left ventricular remodelling across diverse clinical interventions.

Abstract

Background: Cardiovascular interventions may impact both left ventricular mass (LVM) and end-diastolic volume (EDV), but the net effect on wall thickness has been difficult to accurately evaluate. Global average left ventricular end-diastolic wall thickness (GT) relates non-linearly to LVM and EDV. We hypothesized that if GT is independent of EDV in health, then GT will be an ideal measure of post-intervention change in left ventricular hypertrophy. Methods: GT [mm] was calculated using LVM and EDV by cardiovascular magnetic resonance as previously validated. The correlation between GT and EDV was evaluated in healthy volunteers. Change in GT following intervention was evaluated for aortic stenosis undergoing valve replacement, hypertension commencing antihypertensive medications, athletes undergoing forced detraining, and aortic regurgitation undergoing valve replacement. The performance of GT was compared to LVM/EDV. Results: Among healthy volunteers (n=4461, mean+/-SD age 59+/-10 years, 50% female), EDV correlated with LVM/EDV but negligibly with GT (R2>0.16 vs R2<0.02, p<0.001 for both sexes). GT and not LVM/EDV changed after intervention in all conditions (p≤0.02 for all). Post-intervention changes in GT varied by condition (mean+/-SEM aortic stenosis [n=102]: -1.75+/-0.13mm, hypertension [n=78]: -0.66+/-0.08mm, athletes [n=28]: -0.29+/-0.09mm, aortic regurgitation [n=58]: +0.50+/-0.11 mm, p≤0.02 for all comparisons). Conclusions: In health, GT, unlike LVM/EDV, remains effectively unchanged across EDV values, indicating that GT is a physiological constant in health and can track pathological changes. After intervention, only GT and not LVM/EDV consistently changed. Instead of LVM/EDV, GT should be used to quantify remodelling after interventions in left ventricular hypertrophy.

Discussion

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Cite This Study

Khor et al. (2026) conducted a cohort in Left ventricular hypertrophy across aortic stenosis, hypertension, athletic remodeling, and aortic regurgitation alongside healthy volunteers (n=4,727). Global average left ventricular end-diastolic wall thickness (GT) assessment by CMR vs. Left ventricular mass-to-end-diastolic volume ratio (LVM/EDV) was evaluated on Post-intervention change in global average left ventricular end-diastolic wall thickness (GT) and correlation with EDV in health (R2<0.02 vs R2>0.16 in health; GT changed in all 4 intervention cohorts (AS -1.75 mm, HTN -0.66 mm, athletes -0.29 mm, AR +0.50 mm), p=≤0.02). Global wall thickness (GT) by CMR had negligible correlation with EDV in health (R2<0.02, p<0.001) and consistently detected post-intervention LVH remodeling across all 4 cohorts (p≤0.02).

synapsesocial.com/papers/6aebc8cf3e63ca1b6c315eb3 https://doi.org/10.64898/2026.11.01.26367004

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Global thickness for accurate and precise evaluation of post-intervention remodelling in left ventricular hypertrophy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Global thickness for accurate and precise evaluation of post-intervention remodelling in left ventricular hypertrophy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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