Background:
Left ventricular hypertrophy (LVH) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of ischemic stroke in a new 4-group LVH classification based on LV concentricity (mass/end-diastolic volume
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) and indexed LV end-diastolic volume (EDV) in the general Chinese population.
Methods:
The cross-sectional study consisted of 11,037 general Chinese population (mean age 54 years; 54% women) from Northeast China Rural Cardiovascular Health (NCRCH) study who underwent echocardiography measurement. A 4-tiered classification of LVH was proposed where eccentric LVH is subdivided into “indeterminate hypertrophy (n=484)” and “dilated hypertrophy (n=386)” and concentric LVH into “thick hypertrophy (n=246)” and “both thick and dilated hypertrophy (n=138)” based on the presence of increased LV end-diastolic volume.
Results:
Compared with normal LV geometry (2.6%), indeterminate (7.4%) and thick hypertrophy (10.2%) showed a higher prevalence of ischemic stroke (p<0.05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115–2.398) and thick (2.143 [1.329–3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803–1.950]) and both thick and dilated hypertrophy (0.926 [0.435–1.971]) compared with normal geometry in multivariable analysis. Additionally, the continuous parameters of LV concentricity
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(OR, 1.067; 95% CI, 1.024–1.113 per 1 SD increment) was independently associated with the presence of ischemic stroke in multivariable analysis adjusted for age, sex, race, physical activity, current smoking and drinking status, BMI, TC, hypertension and diabetes, while LVEDV/BSA was not (OR, 0.957; 95% CI, 0.859–1.065 per 1 SD increment).
Conclusions:
In a large-scale Asian population, we identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy.
The association between ECG criteria and Echo criteria for left ventricular hypertrophy in a general Chinese population
