Abstract 237: Prognostic Significance of Left Ventricular Hypertrophy (lvh) by Electrocardiography in a Minority-predominant Heart Failure (hf) Cohort

Background: Left ventricular Hypertrophy (LVH) has been associated with higher cardiovascular morbidity and mortality but most of these studies were conducted in majority (white) populations. LVH is known to be more common in African Americans (AA) who also have a higher prevalence of cardiovascular morbidity and mortality. The prognostic significance of LVH in AA with Heart Failure (HF) has not been well studied. Methods: We performed a retrospective analysis of a predominantly minority HF cohort (69.3% AA); after obtaining approval from our institutional review board. Our primary goal was to compare the HF outcomes [All-cause hospitalizations (ACH), hospitalizations primarily due to HF and ER visits] in patients with EKG evidence of LVH versus those without LVH. We also examined the racial (Blacks vs Whites), gender (males vs females) and age-based (≥60 Vs <60 years) differential impact of LVH on HF outcomes and determined the prevalence of LVH in the cohort. Levene’s Test and t-test were used to analyze the data for equality of variances and means respectively. Result: Our HF cohort consisted of 599 patients (415 AA, 142 Caucasian, 22 others, 20 unknown). The prevalence of LVH in overall cohort was 26.7%. We noted that black had higher prevalence of LVH ( 31%) vs Whites (15.5%) while prevalence of LVH was not very different in males ( 27.9%) vs females( 25.7%) and ≥60 years of age( 27.5%) vs <60 (27.3%). The analysis showed that there were statistically significant differences in the number of ACH (p-value = 0.014), HF hospitalizations (p-value = 0.019) and ER visits (p-value = 0.001) in the LVH group compared with the non-LVH group. . There were no racial, gender or age-based statistically significant differences in the impact of LVH on HF outcomes. Conclusion: Electrocardiographically determined LVH in a minority - predominant HF cohort is associated with worse outcomes. This needs to be prospectively validated in a larger cohort of HF and could serve as a prognostic marker to guide the care of HF patients.

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Left ventricular hypertrophy in patients treated with regular hemodialyses

Medicinski pregled ◽

10.2298/mpns0808369p ◽

2008 ◽

Vol 61 (7-8) ◽

pp. 369-374 ◽

Cited By ~ 6

Author(s):

Dejan Petrovic ◽

Biljana Stojimirovic

Keyword(s):

Risk Factors ◽

Left Ventricle ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Pressure Overload ◽

Left Ventricular ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Concentric Hypertrophy ◽

Cardiovascular Morbidity And Mortality

Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Left ventricular hypertrophy is found in 75% of the patients treated with hemodialysis. Risk factors for left ventricular hypertrophy in patients on hemodialysis include: blood flow through arterial-venous fistula, anemia, hypertension, increased extracellular fluid volume, oxidative stress, microinflammation, hyperhomocysteinemia, secondary hyperpara- thyroidism, and disturbed calcium and phosphate homeostasis. Left ventricular pressure overload leads to parallel placement of new sarcomeres and development of concentric hypertrophy of left ventricle. Left ventricular hypertrophy advances in two stages. In the stage of adaptation, left ventricular hypertrophy occurs as a response to increased tension stress of the left ventricular wall and its action is protective. When volume and pressure overload the left ventricle chronically and without control, adaptive hypertrophy becomes maladaptive hypertrophy of the left ventricle, where myocytes are lost, systolic function is deranged and heart insufficiency is developed. Left ventricular mass index-LVMi greater than 131 g/m2 in men and greater than 100 g/m2 in women, and relative wall thickness of the left ventricle above 0.45 indicate concentric hypertrophy of the left ventricle. Eccentric hypertrophy of the left ventricle is defined echocardiographically as LVMi above 131 g/m2 in men and greater than 100 g/m2 in women, with RWT ?0.45. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors lead to regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.

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