Coronary artery disease
Left Ventricular Geometry and Survival in Patients With Normal Left Ventricular Ejection Fraction

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In hypertensive populations, left ventricular (LV) geometry, which is characterized by hypertrophy, predicts cardiovascular outcome. The left ventricle can also alter its shape by concentric remodeling (CR) in the absence of LV hypertrophy, a feature that is detected by echocardiography. This study assessed the prevalence and prognostic significance of various forms of LV geometry and changes in LV geometry over time in patients with normal LV systolic function. Retrospective analysis of a large clinical population (n = 35,602) that was referred for echocardiography was done, with all-cause mortality as the primary outcome. Abnormal LV geometry was identified in 46% of patients, with CR present in 35% (n = 12,362) and LV hypertrophy in 11% (n = 3,958). Patients with abnormal LV geometry were older and more obese compared with subjects with normal LV geometry. There was a strong relation between abnormal LV geometry and mortality, and patients with CR and LV hypertrophy exhibited considerably higher relative risk for all-cause mortality compared with subjects with normal LV geometry (relative risk [RR] 1.99, 95% confidence interval [CI] 1.88 to 2.18, p <0.0001; RR 2.13, 95% CI 1.89 to 2.40, p <0.0001, respectively). Subjects with CR who reverted to a normal geometric pattern had improved survival (RR 0.64, 95% CI 0.42 to 0.97, p = 0.03) compared with those who progressed to LV hypertrophy (RR 1.54, 95% CI 1.01 to 2.47, p = 0.05). In conclusion, CR, a form of cardiac adaptation, is frequently noted in patients with normal LV ejection fractions and confers a risk of death similar to that of LV hypertrophy. Normalization of CR is associated with better survival, whereas transition to LV hypertrophy increases mortality.

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Subject selection and echocardiography

We obtained relevant clinical and echocardiographic data from a clinical echocardiographic database of 42,508 studies that were recorded at Ochsner Clinic Foundation (New Orleans, Louisiana) between October 7, 1997 and November 20, 2002, and evaluated a subset of 35,602 patients who met the inclusion criteria of having a normal ejection fraction (≥50%), a United States residence, and absence of significant aortic stenosis. Survival status was obtained from the National Death Index in the entire

Baseline characteristics and patterns of LV geometry

Baseline characteristics of the cohort are listed in Table 1. Abnormal LV geometry was identified in 46% of all patients in the cohort. CR was the most frequently observed abnormal LV geometric pattern and was identified in 35% (n = 12,362) of the cohort (Figure 1).Table 2 presents the characteristics of patients grouped by LV geometry. Abnormal LV geometry was associated with older age and greater prevalence of obesity compared with subjects with normal geometry.

LV geometry and survival

There was a strong relation

Discussion

There are several important implications of this study. First, abnormal LV geometry, in particular CR, is a very common echocardiographic finding in the routine evaluation of patients with preserved LV ejection fraction. Second, the presence of CR in the general cardiovascular population, regardless of age or gender, confers a marked increase in all-cause mortality risk over time. Third, in patients who exhibit CR, further alteration of LV structure over time can have a significant effect on

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