Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2015 Sep;8(9):1034-1041.
doi: 10.1016/j.jcmg.2015.06.007. Epub 2015 Aug 19.

Association of a 4-Tiered Classification of LV Hypertrophy With Adverse CV Outcomes in the General Population

Sonia Garg  1 , James A de Lemos  1 , Colby Ayers  2 , Michel G Khouri  3 , Ambarish Pandey  1 , Jarett D Berry  4 , Ronald M Peshock  5 , Mark H Drazner  6
Affiliations
Comparative Study

Association of a 4-Tiered Classification of LV Hypertrophy With Adverse CV Outcomes in the General Population

Sonia Garg et al. JACC Cardiovasc Imaging. 2015 Sep.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] JACC Cardiovasc Imaging. 2017 Dec;10(12):1537. doi: 10.1016/j.jcmg.2017.10.013. JACC Cardiovasc Imaging. 2017. PMID: 29216981 No abstract available.

Abstract

Objectives: This study was performed to determine whether a 4-tiered classification of left ventricular hypertrophy (LVH) defines subgroups in the general population that are at variable risks of adverse cardiovascular (CV) outcomes.

Background: We recently proposed a 4-tiered classification of LVH where eccentric LVH is subdivided into "indeterminate hypertrophy" and "dilated hypertrophy" and concentric LVH into "thick hypertrophy" and "both thick and dilated hypertrophy," based on the presence of increased left ventricular (LV) end-diastolic volume.

Methods: Participants from the Dallas Heart study who underwent cardiac magnetic resonance and did not have LV dysfunction or a history of heart failure (HF) (n = 2,458) were followed for a median of 9 years for the primary outcome of HF or CV death. Multivariable Cox proportional hazards models were used to adjust for age, sex, African-American race, hypertension, diabetes, and history of CV disease.

Results: In the cohort, 70% had no LVH, 404 (16%) had indeterminate hypertrophy, 30 (1%) had dilated hypertrophy, 289 (12%) had thick hypertrophy, and 7 (0.2%) had both thick and dilated hypertrophy. The cumulative incidence of HF or CV death was 2% with no LVH, 1.7% with indeterminate, 16.7% with dilated, 11.1% with thick, and 42.9% with both thick and dilated hypertrophy (log-rank p < 0.0001). Compared with participants without LVH, those with dilated (hazard ratio [HR]: 7.3; 95% confidence interval [CI]: 2.8 to 18.8), thick (HR: 2.4; 95% CI: 1.4 to 4.0), and both thick and dilated (HR: 5.8; 95% CI: 1.7 to 19.5) hypertrophy remained at increased risk for HF or CV death after multivariable adjustment, whereas the group with indeterminate hypertrophy was not (HR: 0.9; 95% CI: 0.4 to 2.2).

Conclusions: In the general population, the 4-tiered classification system for LVH stratified LVH into subgroups with differential risk of adverse CV outcomes.

Keywords: cardiac magnetic resonance; heart failure; hypertrophy; left ventricular geometry; troponin.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Schematic of standard 2-tier and 4-tier classification for LVH
Both of the standard 2-tiered subgroups are sub-classified based on the presence of increased indexed LV volume. Cited with permission from Khouri et al.(6)
Figure 2
Figure 2. Prevalence of elevated hs-cTnT in the 2-tier (A) and 4-tier (B) classification for LVH
*p<0.001 versus no LVH group. †p<0.02 versus no LVH group. LVH = left ventricular hypertrophy
Figure 2
Figure 2. Prevalence of elevated hs-cTnT in the 2-tier (A) and 4-tier (B) classification for LVH
*p<0.001 versus no LVH group. †p<0.02 versus no LVH group. LVH = left ventricular hypertrophy
Figure 3
Figure 3. Kaplan-Meier curves for Incident HF or CV Death
Unadjusted Kaplan-Meier curves for cardiovascular (CV) death or incident heart failure (HF) stratified by 2-tier (A) and 4-tier (B) classification for LVH. CHF = congestive heart failure. CV = cardiovascular death. LVH = left ventricular hypetrophy.
Figure 3
Figure 3. Kaplan-Meier curves for Incident HF or CV Death
Unadjusted Kaplan-Meier curves for cardiovascular (CV) death or incident heart failure (HF) stratified by 2-tier (A) and 4-tier (B) classification for LVH. CHF = congestive heart failure. CV = cardiovascular death. LVH = left ventricular hypetrophy.
See this image and copyright information in PMC

Comment in

References

    1. Drazner MH, Rame JE, Marino EK, et al. Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: the Cardiovascular Health Study. J Am Coll Cardiol. 2004;43:2207–15. - PubMed
    1. Gottdiener JS, Arnold AM, Aurigemma GP, et al. Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study. J Am Coll Cardiol. 2000;35:1628–37. - PubMed
    1. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–6. - PubMed
    1. Velagaleti RS, Gona P, Pencina MJ, et al. Left ventricular hypertrophy patterns and incidence of heart failure with preserved versus reduced ejection fraction. Am J Cardiol. 2014;113:117–22. - PMC - PubMed
    1. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr. 2015;28:1–39. e14. - PubMed

Publication types

MeSH terms