Progression from Concentric Left Ventricular Hypertrophy and Normal Ejection Fraction to Left Ventricular Dysfunction

• Published in: The American journal of cardiology Vol. 108; no. 7; pp. 992 - 996
• Main Authors: Milani, Richard V., Drazner, Mark H., Lavie, Carl J., Morin, Daniel P., Ventura, Hector O.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2011; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular system; Disease Progression; Echocardiography, Doppler; Female; Follow-Up Studies; Heart; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertrophy, Left Ventricular - complications; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - physiopathology; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Prognosis; Retrospective Studies; Risk factors; Stroke Volume - physiology; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Prognosis; Cardiovascular disease; Heart ventricle; Left ventricular failure; Normal; Left ventricle; Heart disease; Evolution; Ventricular ejection; Circulatory system; Hemodynamics; Cardiology; Left ventricle performance; Ejection fraction; Hypertrophy
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2011.05.038

Concentric left ventricular (LV) hypertrophy develops in response to a chronically increased LV afterload and is associated with increased cardiovascular events. Although the progression to systolic and diastolic heart failure is a known consequence of LV hypertrophy, few data are available on the frequency of deterioration to systolic dysfunction in patients with LV hypertrophy who originally had a normal LV ejection fraction. We evaluated the baseline and follow-up characteristics in 1,024 patients with concentric LV hypertrophy and a normal ejection fraction who had paired echocardiograms that were separated by ≥1 year. Systolic dysfunction occurred in 134 patients (13%) after a mean follow-up of 33 ± 24 months. The most common associated variable was interval myocardial infarction, which occurred in 43% of patients. Other risk factors for developing LV systolic dysfunction included QRS prolongation (>120 ms) and elevated follow-up arterial impedance defined as a value >4.0 mm Hg/ml/m 2. Patients with either a prolonged QRS interval or an elevated follow-up arterial impedance had twice the likelihood of developing LV systolic dysfunction, and, if both factors were present, there was a greater than fourfold increased risk of developing systolic dysfunction. Blood pressure measurements alone did not adequately reflect an elevated arterial impedance. In conclusion, 13% of patients with a normal ejection fraction and concentric LV hypertrophy progress to systolic dysfunction during approximately 3 years of follow-up. The risk factors for loss of function were interval myocardial infarction, prolonged QRS, and chronically elevated arterial impedance.