Prevalence Clinical Characteristics and Outcomes Associated with Eccentric versus Concentric Left Ventricular Hypertrophy In Heart Failure with Preserved Ejection Fraction

摘要

While concentric remodeling (CR) and concentric hypertrophy (CH) are common forms of left ventricular (LV) remodeling in heart failure with preserved ejection fraction (HFpEF), eccentric hypertrophy (EH) can also occur in these patients. However, clinical characteristics and outcomes of EH have not been well described in HFpEF. We prospectively studied 402 patients with HFpEF, divided into 4 groups based on LV structure: normal geometry (no LV hypertrophy [LVH] and relative wall thickness [RWT] < 0.42); CR (no LVH and RWT > 0.42); CH (LVH and RWT > 0.42); and EH (LVH and RWT < 0.42). We compared clinical, laboratory, echocardiographic, invasive hemodynamic, and outcome data among groups. Of 402 patients, 48 (12%) had EH. Compared to CH, patients with EH had lower systolic blood pressure and less renal impairment despite similar rates of hypertension. After adjustment for covariates, EH was associated with reduced LV contractility compared to CH (lower LVEF [β-coefficient = −3.2; 95% confidence interval (CI) −5.4, −1.1%] and ratio of systolic blood pressure to end-systolic volume [β-coefficient = −1.0; 95% CI −1.5, −0.5 mmHg/ml]). EH was also associated with increased LV compliance compared to CH (LV end-diastolic volume at an idealized LV end-diastolic pressure of 20 mmHg [EDV20] β-coefficient = 14.2;95% CI 9.4, 19.1 ml). Despite these differences, EH and CH had similarly elevated cardiac filling pressures and equivalent adverse outcomes. In conclusion, the presence of EH denotes a distinct subset of HFpEF that is pathophysiologically similar to HF with reduced EF (HFrEF), and may benefit from HFrEF therapy.