Abstract
BackgroundThe utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort.MethodsWe conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes.ResultsOver a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04–1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11–1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07–2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19–2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09–1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05).ConclusionsOur prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes.
Highlights
The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized
Role of abnormal LV geometry in predicting adverse outcomes at follow‐up According to Kaplan–Meier survival estimates, higher cumulative incidences of stroke/CHD and all-cause mortality were observed among participants with abnormal LV geometry when compared to those with normal geometry in total population (Fig. 1) or each sex group (Fig. 2)
LAD left atrial diameter, Interventricular septal thickness (IVSd) interventricular septal thickness, LV end-diastolic internal (LVIDd) left ventricular end-diastolic internal dimension, LV end-systolic internal dimension (LVIDs) left ventricular end-systolic internal dimension, PWTd posterior wall thickness, Left ventricular mass (LVM) left ventricular mass, LVM index (LVMI) left ventricular mass index, RWTrelative wall thickness, LV end-diastolic volume (LVEDV) left ventricular end-diastolic volume, LV end-systolic volume (LVESV) left ventricular end-systolic volume, SV systolic volume, LV ejection fraction (LVEF) left ventricular ejection fraction, FS fractional shortening, E early diastolic peak flow, A atrial peak flow eccentric hypertrophy was associated with the risk of all-cause mortality (HR = 1.68, 95% confidence interval (CI) = 1.16–2.44)
Summary
The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. Irrespective of etiology, abnormal LV geometry is considered a valuable echocardiographic phenotype that reflects the severity and chronicity of cardiovascular risk factors, suggesting their potential to offer better prognostic information than traditional ones [4,5,6,7]. In this regard, the contribution of LV geometry to clinical prognosis has been extensively explored in a variety of cardiovascular disease (CVD) settings
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