Influence of Echocardiographic Criteria on the Prevalence and Prognostic Implication of Left Ventricular Hypertrophy: A Nationwide Population-Based Study

Abstract

Background: Echocardiographic criteria of left ventricular hypertrophy (LVH) recommended in the international guidelines are derived from a White population, which could be less accurate in estimating LVH burden in other ethnic groups. Given that LVH is an important prognostic factor, assessing its burden using ethnically specific criteria has important implications. We sought to evaluate the prevalence and prognostic implications of LVH based on the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) study criteria and the international guidelines.

Methods and results: Nationally representative populations aged ≥35 years (n=20 210; mean age, 56.0 years; 53.3% women) were enrolled from the China Hypertension Survey 2012 to 2015. The EMINCA study criteria for LVH were left ventricular mass index >109 g/m² for men and >105 g/m² for women; and the international guidelines criteria were left ventricular mass index >115 g/m² for men and >95 g/m² for women. Prevalence of LVH defined by the EMINCA study and international guidelines was 8.3% (≈56.8 million) and 11.7% (≈80.1 million), respectively. LVH defined by the EMINCA study was associated with adjusted hazard ratio (HR) of 1.55 (95% CI, 1.19-2.01; P<0.001) for cardiovascular death and 1.14 (95% CI, 0.95-1.37; P=0.16) for all-cause death. LVH defined by the international guidelines was associated with adjusted HR of 1.31 (95% CI, 1.00-1.72; P=0.047) for cardiovascular death and 1.12 (95% CI, 0.94-1.34; P=0.22) for all-cause death.

Conclusions: LVH diagnosis based on both criteria was independently associated with cardiovascular death. However, the prevalence of LVH in a general Chinese population varies significantly by the echocardiographic criteria.

Keywords: left ventricular hypertrophy; prevalence; prognosis.

Figure 1. Cumulative rate of cardiovascular and all‐cause death at follow‐up by LVH status.

A, At follow‐up, the cumulative rate of CV death was higher in people with LVH than those without LVH (log‐rank P<0.0001). B, At follow‐up, the cumulative rate of all‐cause death was higher in people with LVH than in those without LVH (log‐rank P<0.0001). CV indicates cardiovascular; and LVH, left ventricular hypertrophy.

Figure 2. Association between LVH and cardiovascular and all‐cause death by age, sex, and urbanity.

LVH was associated with higher risk for CV death and all‐cause death in people aged <65 years vs those aged ≥65 years (P‐interaction=0.002 and P‐interaction=0.03). There was no significant interaction between sex, urbanity, and LVH for CV death and all‐cause death (all P‐interaction >0.05). CV indicates cardiovascular; HR, hazard ratio; and LVH, left ventricular hypertrophy.