Prevalence, Clinical Characteristics, and Outcomes Associated With Eccentric Versus Concentric Left Ventricular Hypertrophy in Heart Failure With Preserved Ejection Fraction

• Published in: The American journal of cardiology Vol. 112; no. 8; pp. 1158 - 1164
• Main Authors: Katz, Daniel H., BA, Beussink, Lauren, MHS, RDCS, Sauer, Andrew J., MD, Freed, Benjamin H., MD, Burke, Michael A., MD, Shah, Sanjiv J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.10.2013; Elsevier Limited
• Subjects: Aged; Blood pressure; Cardiology; Cardiovascular; Disease Progression; Drug therapy; Echocardiography; Female; Follow-Up Studies; Fractions; Geometry; Heart attacks; Heart failure; Heart Failure - complications; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Hospitalization; Humans; Hypertrophy, Left Ventricular - epidemiology; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Illinois - epidemiology; Male; Middle Aged; Prevalence; Prognosis; Prospective Studies; Pulmonary arteries; Stroke; Stroke Volume - physiology; Veins & arteries; Ventricular Remodeling
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.05.061

Although 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 with 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 with CH: lower LVEF (β coefficient = −3.2; 95% confidence interval [CI] −5.4 to −1.1%) and ratio of systolic blood pressure to end-systolic volume (β coefficient = −1.0; 95% CI −1.5 to −0.5 mm Hg/ml). EH was also associated with increased LV compliance compared with CH (LV end-diastolic volume at an idealized LV end-diastolic pressure of 20 mm Hg β coefficient = 14.2; 95% CI 9.4 to 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.