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. 2021 May 10;22(6):670-679.
doi: 10.1093/ehjci/jeaa040.

The remodelling index risk stratifies patients with hypertensive left ventricular hypertrophy

Thu-Thao Le  1   2 , Vanessa Lim  1 , Rositaa Ibrahim  1   3 , Muh-Tyng Teo  1 , Jennifer Bryant  1 , Briana Ang  1 , Boyang Su  1 , Tar-Choon Aw  4 , Chi-Hang Lee  1 , Jeroen Bax  5 , Stuart Cook  1   2 , Calvin W L Chin  1   2
Affiliations

The remodelling index risk stratifies patients with hypertensive left ventricular hypertrophy

Thu-Thao Le et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. We previously developed the remodelling index (RI) that incorporated left ventricular (LV) volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients. This study examined the prognostic potential of the RI in reference to contemporary LVH classifications.

Methods and results: Cardiovascular magnetic resonance was performed in 400 asymptomatic hypertensive patients. The newly derived RI (EDV3t, where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients: no LVH, LVH with normal RI (LVHNormal-RI), and LVH with low RI (LVHLow-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes, and decompensated heart failure. LVHLow-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury (high-sensitive cardiac troponin I), and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), 14 adverse events occurred (2.2 events/100 patient-years). Patients with LVHLow-RI had more than a five-fold increase in adverse events compared to those with LVHNormal-RI (11.6 events/100 patient-years vs. 2.0 events/100 patient-years, respectively; log-rank P < 0.001). The RI provided incremental prognostic value over and above a model consisting of clinical variables, LVH and concentricity; and predicted adverse events independent of clinical variables, LVH, and other prognostic markers. Concentric and eccentric LVH were associated with adverse prognosis (log-rank P = 0.62) that was similar to the natural history of hypertensive LVH (5.1 events/100 patient-years).

Conclusion: The RI provides prognostic value that improves risk stratification of hypertensive LVH.

Keywords: cardiac remodelling; cardiovascular magnetic resonance; hypertensive heart disease; left ventricular hypertrophy.

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Figures

Figure 1
Figure 1
Myocardial wall stress and the development of the remodelling index.
Figure 2
Figure 2
Geometric patterns of hypertensive left ventricular hypertrophy (A) and after classification by the remodelling index (B).
Figure 3
Figure 3
Myocardial function in hypertensive left ventricular hypertrophy assessed using left ventricular ejection fraction (A) and myocardial deformation and peak flow acceleration (B). Results were presented in mean and 95% confidence interval, adjusted for age, sex, and systolic blood pressure.
Figure 4
Figure 4
Event-free survival associated with left ventricular hypertrophy stratified by the remodelling index (A) and conventional geometric classification (B). Incremental prognostic value of the remodelling index compared with conventional markers (C).
See this image and copyright information in PMC

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