Adverse Left Ventricular Remodeling in Community-Dwelling Older Adults Predicts Incident Heart Failure and Mortality

• Published in: JACC. Heart failure Vol. 2; no. 5; pp. 512 - 522
• Main Authors: Zile, Michael R., MD, Gaasch, William H., MD, Patel, Kanan, MBBS, MPH, Aban, Inmaculada B., MS, PhD, Ahmed, Ali, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2014
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Female; heart failure; Heart Failure - epidemiology; Heart Failure - mortality; Heart Ventricles - diagnostic imaging; Humans; Hypertension - epidemiology; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - epidemiology; Incidence; left ventricle; Male; Myocardial Infarction - epidemiology; Prognosis; Renal Insufficiency, Chronic - epidemiology; structural remodeling; Ultrasonography; Ventricular Remodeling; heart failure; EF; ejection fraction; left ventricle; structural remodeling; HR; LV; cardiovascular; RWT; CV; left ventricular enlargement; left ventricular hypertrophy; hazard ratio; LVE; left ventricular; relative wall thickness; HF; LVH
• ISSN: 2213-1779; 2213-1787
• DOI: 10.1016/j.jchf.2014.03.016

Abstract Objectives This study sought to determine whether specific patterns of adverse left ventricular (LV) structural remodeling are associated with differential rates of cardiovascular (CV) outcomes. Background It is not known whether a stepwise combinatorial assessment of LV volume, mass, and geometry done to define specific remodeling patterns provides incremental prognostic information. Methods A total of 3,181 Cardiovascular Health Study participants (mean age, 73 years of age; 60% women, 5% African American) were categorized by LV remodeling patterns and related to a multivariate-adjusted (age, sex, race, ejection fraction, hypertension, myocardial infarction, diabetes mellitus, chronic kidney disease) analysis of CV outcomes (incident heart failure [HF], all-cause mortality, and a combined endpoint of HF and mortality) over a 13-year follow-up period. Results Examined independently, either left ventricular enlargement (LVE) or left ventricular hypertrophy (LVH) was associated with a higher risk of HF (32%, 34%, respectively) than with normal geometry (17%; p < 0.001). When LV volume and mass were used in combination, important incremental prognostic information was achieved. In the absence of LVE, HF was more common in those with LVH than in those with normal mass (32% vs. 16%, respectively; p < 0.001). In the presence of LVE, HF was more common in those with LVH than in those with normal mass (37% vs. 29%, respectively; p = 0.021). The subgroup with normal volume and mass but relative wall thickness (RWT) >0.42 carried a higher risk of HF (21%) than those with normal geometry (15%; p = 0.011). Once LVH or LVE was present, the addition of RWT to this analysis did not affect HF rate. Similar results were obtained for the other CV outcomes. Conclusions Stepwise combinatorial assessment of LV volume, mass, and geometry provides incremental prognostic information regarding CV outcomes.