Adverse left ventricular remodeling in community-dwelling older adults predicts incident heart failure and mortality.
Pubmed ID: 25194295
Journal: JACC. Heart failure
Publication Date: Oct. 1, 2014
MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Hypertension, Heart Failure, Prognosis, Incidence, Myocardial Infarction, Renal Insufficiency, Chronic, Hypertrophy, Left Ventricular, Heart Ventricles, Ventricular Remodeling, Ultrasonography
Grants: R01-HL097047
Authors: Ahmed A, Aban IB, Zile MR, Patel K, Gaasch WH
Cite As: Zile MR, Gaasch WH, Patel K, Aban IB, Ahmed A. Adverse left ventricular remodeling in community-dwelling older adults predicts incident heart failure and mortality. JACC Heart Fail 2014 Oct;2(5):512-22. Epub 2014 Sep 3.
Studies:
- Cardiovascular Health Study (CHS)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
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.