Natural History of Concentric Left Ventricular Geometry in Community-Dwelling Older Adults without Heart Failure during Seven Years of Follow-up

摘要

The 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 5795 community-dwelling adults, ≥65 years, in the Cardiovascular Health Study, 1871 without baseline heart failure had data on baseline and 7-year echocardiography. Of these 343 (18%) had baseline concentric LV geometry (concentric remodeling, 83% and concentric LV hypertrophy, 17%) and are the focus of the current study. LV geometry at year 7 was categorized into 4 groups based on LV hypertrophy (LVH; LV mass indexed for height >51 g/m^2.7) 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. Prior myocardial infarction and baseline above-median LV mass (>39 g/m^2.7) and RWT (>0.46) had significant unadjusted associations with incident eccentric LV hypertrophy; however, only LV mass >39 g/m^2.7 (odds ratio, 17.52; 95% CI, 3.91–78.47; p<0.001) and prior myocardial infarction (odds ratio, 4.73; 95% CI, 1.16–19.32; 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.