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Natural History of Concentric Left Ventricular Geometry in Community-Dwelling Older Adults Without Heart Failure During Seven Years of Follow-Up

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Presence of concentric left ventricular (LV) geometry has important pathophysiologic and prognostic implications. However, little is known about its natural history in older adults. Of the 5,795 community-dwelling adults ≥65 years of age in the Cardiovascular Health Study, 1,871 without baseline heart failure had data on baseline and 7-year echocardiograms. Of these 343 (18%) had baseline concentric LV geometry (concentric remodeling 83%, concentric LV hypertrophy [LVH] 17%) and are the focus of the present study. LV geometry at year 7 was categorized into 4 groups based on LVH (LV mass indexed for height >51 g/m2.7) and relative wall thickness (RWT): eccentric hypertrophy (RWT ≤0.42 with LVH), concentric hypertrophy (RWT >0.42 with LVH), concentric remodeling (RWT >0.42 without LVH), and normal (RWT ≤0.42 without LVH). At year 7, LV geometry normalized in 57%, remained unchanged in 35%, and transitioned to eccentric hypertrophy in 7% of participants. Incident eccentric hypertrophy occurred in 4% and 25% of those with baseline concentric remodeling and concentric hypertrophy, respectively, and was associated with increased LV end-diastolic volume and decreased LV ejection fraction at year 7. Previous myocardial infarction and baseline above-median LV mass (>39 g/m2.7) and RWT (>0.46) had significant unadjusted associations with incident eccentric LVH; however, only LV mass >39 g/m2.7 (odds ratio 17.52, 95% confidence interval 3.91 to 78.47, p <0.001) and previous myocardial infarction (odds ratio 4.73, 95% confidence interval 1.16 to 19.32, p = 0.031) had significant independent associations. In conclusion, in community-dwelling older adults with concentric LV geometry, transition to eccentric hypertrophy was uncommon but structurally maladaptive.

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Methods

The Cardiovascular Health Study (CHS) is an ongoing epidemiologic study of cardiovascular disease in community-dwelling adults ≥65 years of age in the United States; details of the rationale, design, and implementation have been previously detailed.7, 8, 9 Of the 5,888 CHS participants, data on 5,795 participants were available in the de-identified public-use copies of the datasets (93 participants declined to be included in these datasets). Of the 5,795 CHS participants, 1,871 were free of HF

Results

Participants (n = 343) had a mean ± SD age of 73 ± 5 years and a mean ± SD LV mass of 155 ± 51 g, 63% were women, 8% were African-Americans, and 59% had a history of hypertension (Table 1). At year 7, LV geometry normalized in 57% of participants, remained unchanged in 35%, and progressed to eccentric hypertrophy in 7%. Of those with LV concentric remodeling at baseline, LV geometry normalized in 63%, remained unchanged in 31%, and progressed to concentric hypertrophy in 3% and eccentric

Discussion

Findings from the present study demonstrate that the natural history of LV concentric geometry is dynamic in nature and that >1/2 regressed to or toward a more normal geometry and about 1/4 showed no change in LV geometry over 7 years of follow-up. Regardless of an intercurrent AMI, only a small minority of patients with concentric remodeling and nearly 1/4 of those with concentric hypertrophy developed eccentric hypertrophy. Previous AMI and baseline LV mass were significant independent

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The Cardiovascular Health Study was conducted and supported by the National Heart, Lung, and Blood Institute, Bethesda, Maryland in collaboration with the Cardiovascular Health Study investigators. This manuscript was prepared using a limited access dataset obtained from the NHLBI and does not necessarily reflect the opinions or views of the CHS or the NHLBI.

Dr. Ahmed is supported by the National Institutes of Health, Bethesda, Maryland through Grants R01-HL085561 and R01-HL097047 from the National Heart, Lung, and Blood Institute and a generous gift from Ms. Jean B. Morris of Birmingham, Alabama. Dr. Zile is funded by the Research Service of the Department of Veterans Affairs, Washington, DC.

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Published by Elsevier Inc.