The remodelling index risk stratifies patients with hypertensive left ventricular hypertrophy. (7th April 2020)

• Record Type: Journal Article
• Authors: Le, Thu-Thao; Lim, Vanessa; Ibrahim, Rositaa; Teo, Muh-Tyng; Bryant, Jennifer; Ang, Briana; Su, Boyang; Aw, Tar-Choon; Lee, Chi-Hang; Bax, Jeroen; Cook, Stuart; Chin, Calvin W L
• Is Part Of: European heart journal. Volume 22:Number 6(2021)
• Page Start: 670
• Page End: 679
• Publication Date: 2020-04-07
• Subjects: hypertensive heart disease -- left ventricular hypertrophy -- cardiac remodelling -- cardiovascular magnetic resonance; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa040
• Languages: English
• ISSNs: 2047-2404

Abstract

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 (EDV 3 t, 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.