"Malignant" left ventricular hypertrophy identifies subjects at high risk for progression to asymptomatic left ventricular dysfunction, heart failure, and death: MESA (Multi-Ethnic Study of Atherosclerosis)

Matthew N. Peters, Stephen L. Seliger, Robert H. Christenson, Susie N. Hong-Zohlman, Lori B. Daniels, Joao A.C. Lima, James A de Lemos, Ian J Neeland, Christopher R. de Filippi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background--As heart failure (HF)-associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. "Malignant" left ventricular (LV) hypertrophy (LVH): LVH combined with an elevated cardiac biomarker reflecting either injury (high-sensitivity cardiac troponin T), or strain (amino-terminal pro-B-type natriuretic peptide) has predicted accelerated progression to HF. We sought to determine whether malignant LVH identified community-dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in LV ejection fraction or a clinical cardiovascular event. Methods and Results--A total of 4985 of 6814 individuals without prevalent cardiovascular disease underwent baseline cardiac magnetic resonance for LVH in combination with measurement of plasma high-sensitivity cardiac troponin T and amino-terminal pro-B-type natriuretic peptide as part of MESA (Multi-Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No LVH, no elevated biomarkers (n=2206; 44.3%); (2) No LVH, ≥1 elevated biomarkers (n=2275; 45.7%); (3) LVH, no elevated biomarkers (n=153; 3.0%); and (4) LVH, ≥1 elevated biomarkers (malignant LVH; n=351; 7.0%). Cardiac magnetic resonance was repeated 10 years later (n=2831) for assessment of LV ejection fraction < 50%. Median follow-up was 12.2 years. Malignant LVH was associated with 7.0-, 3.5-, and 2.6-fold adjusted increases in incidence of HF, cardiovascular death, and asymptomatic LV dysfunction, respectively, versus group 1. New-onset HF was predominately HF with reduced ejection fraction (9.5-fold increase). Conclusions--Malignant LVH is predictive of progression to asymptomatic LV dysfunction, HF (particularly HF with reduced ejection fraction), and cardiovascular death. Consequently, malignant LVH represents a high-risk phenotype among individuals without known cardiovascular disease, which should be targeted for increased surveillance and more-aggressive therapies.

Original languageEnglish (US)
Article numbere006619
JournalJournal of the American Heart Association
Volume7
Issue number4
DOIs
StatePublished - Feb 1 2018

Fingerprint

Left Ventricular Dysfunction
Left Ventricular Hypertrophy
Hypertrophy
Atherosclerosis
Heart Failure
Biomarkers
Troponin T
Cardiovascular Diseases
Brain Natriuretic Peptide
Stroke Volume
Magnetic Resonance Spectroscopy
Independent Living
Morbidity
Phenotype

Keywords

  • Heart failure
  • Left ventricular dysfunction
  • Left ventricular hypertrophy
  • Mortality
  • N-terminal pro-B-type
  • Troponin T

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

"Malignant" left ventricular hypertrophy identifies subjects at high risk for progression to asymptomatic left ventricular dysfunction, heart failure, and death : MESA (Multi-Ethnic Study of Atherosclerosis). / Peters, Matthew N.; Seliger, Stephen L.; Christenson, Robert H.; Hong-Zohlman, Susie N.; Daniels, Lori B.; Lima, Joao A.C.; de Lemos, James A; Neeland, Ian J; de Filippi, Christopher R.

In: Journal of the American Heart Association, Vol. 7, No. 4, e006619, 01.02.2018.

Research output: Contribution to journalArticle

@article{e0b8adfb697a41d8816f4d2876322e22,
title = "{"}Malignant{"} left ventricular hypertrophy identifies subjects at high risk for progression to asymptomatic left ventricular dysfunction, heart failure, and death: MESA (Multi-Ethnic Study of Atherosclerosis)",
abstract = "Background--As heart failure (HF)-associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. {"}Malignant{"} left ventricular (LV) hypertrophy (LVH): LVH combined with an elevated cardiac biomarker reflecting either injury (high-sensitivity cardiac troponin T), or strain (amino-terminal pro-B-type natriuretic peptide) has predicted accelerated progression to HF. We sought to determine whether malignant LVH identified community-dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in LV ejection fraction or a clinical cardiovascular event. Methods and Results--A total of 4985 of 6814 individuals without prevalent cardiovascular disease underwent baseline cardiac magnetic resonance for LVH in combination with measurement of plasma high-sensitivity cardiac troponin T and amino-terminal pro-B-type natriuretic peptide as part of MESA (Multi-Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No LVH, no elevated biomarkers (n=2206; 44.3{\%}); (2) No LVH, ≥1 elevated biomarkers (n=2275; 45.7{\%}); (3) LVH, no elevated biomarkers (n=153; 3.0{\%}); and (4) LVH, ≥1 elevated biomarkers (malignant LVH; n=351; 7.0{\%}). Cardiac magnetic resonance was repeated 10 years later (n=2831) for assessment of LV ejection fraction < 50{\%}. Median follow-up was 12.2 years. Malignant LVH was associated with 7.0-, 3.5-, and 2.6-fold adjusted increases in incidence of HF, cardiovascular death, and asymptomatic LV dysfunction, respectively, versus group 1. New-onset HF was predominately HF with reduced ejection fraction (9.5-fold increase). Conclusions--Malignant LVH is predictive of progression to asymptomatic LV dysfunction, HF (particularly HF with reduced ejection fraction), and cardiovascular death. Consequently, malignant LVH represents a high-risk phenotype among individuals without known cardiovascular disease, which should be targeted for increased surveillance and more-aggressive therapies.",
keywords = "Heart failure, Left ventricular dysfunction, Left ventricular hypertrophy, Mortality, N-terminal pro-B-type, Troponin T",
author = "Peters, {Matthew N.} and Seliger, {Stephen L.} and Christenson, {Robert H.} and Hong-Zohlman, {Susie N.} and Daniels, {Lori B.} and Lima, {Joao A.C.} and {de Lemos}, {James A} and Neeland, {Ian J} and {de Filippi}, {Christopher R.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1161/JAHA.117.006619",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - "Malignant" left ventricular hypertrophy identifies subjects at high risk for progression to asymptomatic left ventricular dysfunction, heart failure, and death

T2 - MESA (Multi-Ethnic Study of Atherosclerosis)

AU - Peters, Matthew N.

AU - Seliger, Stephen L.

AU - Christenson, Robert H.

AU - Hong-Zohlman, Susie N.

AU - Daniels, Lori B.

AU - Lima, Joao A.C.

AU - de Lemos, James A

AU - Neeland, Ian J

AU - de Filippi, Christopher R.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background--As heart failure (HF)-associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. "Malignant" left ventricular (LV) hypertrophy (LVH): LVH combined with an elevated cardiac biomarker reflecting either injury (high-sensitivity cardiac troponin T), or strain (amino-terminal pro-B-type natriuretic peptide) has predicted accelerated progression to HF. We sought to determine whether malignant LVH identified community-dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in LV ejection fraction or a clinical cardiovascular event. Methods and Results--A total of 4985 of 6814 individuals without prevalent cardiovascular disease underwent baseline cardiac magnetic resonance for LVH in combination with measurement of plasma high-sensitivity cardiac troponin T and amino-terminal pro-B-type natriuretic peptide as part of MESA (Multi-Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No LVH, no elevated biomarkers (n=2206; 44.3%); (2) No LVH, ≥1 elevated biomarkers (n=2275; 45.7%); (3) LVH, no elevated biomarkers (n=153; 3.0%); and (4) LVH, ≥1 elevated biomarkers (malignant LVH; n=351; 7.0%). Cardiac magnetic resonance was repeated 10 years later (n=2831) for assessment of LV ejection fraction < 50%. Median follow-up was 12.2 years. Malignant LVH was associated with 7.0-, 3.5-, and 2.6-fold adjusted increases in incidence of HF, cardiovascular death, and asymptomatic LV dysfunction, respectively, versus group 1. New-onset HF was predominately HF with reduced ejection fraction (9.5-fold increase). Conclusions--Malignant LVH is predictive of progression to asymptomatic LV dysfunction, HF (particularly HF with reduced ejection fraction), and cardiovascular death. Consequently, malignant LVH represents a high-risk phenotype among individuals without known cardiovascular disease, which should be targeted for increased surveillance and more-aggressive therapies.

AB - Background--As heart failure (HF)-associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. "Malignant" left ventricular (LV) hypertrophy (LVH): LVH combined with an elevated cardiac biomarker reflecting either injury (high-sensitivity cardiac troponin T), or strain (amino-terminal pro-B-type natriuretic peptide) has predicted accelerated progression to HF. We sought to determine whether malignant LVH identified community-dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in LV ejection fraction or a clinical cardiovascular event. Methods and Results--A total of 4985 of 6814 individuals without prevalent cardiovascular disease underwent baseline cardiac magnetic resonance for LVH in combination with measurement of plasma high-sensitivity cardiac troponin T and amino-terminal pro-B-type natriuretic peptide as part of MESA (Multi-Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No LVH, no elevated biomarkers (n=2206; 44.3%); (2) No LVH, ≥1 elevated biomarkers (n=2275; 45.7%); (3) LVH, no elevated biomarkers (n=153; 3.0%); and (4) LVH, ≥1 elevated biomarkers (malignant LVH; n=351; 7.0%). Cardiac magnetic resonance was repeated 10 years later (n=2831) for assessment of LV ejection fraction < 50%. Median follow-up was 12.2 years. Malignant LVH was associated with 7.0-, 3.5-, and 2.6-fold adjusted increases in incidence of HF, cardiovascular death, and asymptomatic LV dysfunction, respectively, versus group 1. New-onset HF was predominately HF with reduced ejection fraction (9.5-fold increase). Conclusions--Malignant LVH is predictive of progression to asymptomatic LV dysfunction, HF (particularly HF with reduced ejection fraction), and cardiovascular death. Consequently, malignant LVH represents a high-risk phenotype among individuals without known cardiovascular disease, which should be targeted for increased surveillance and more-aggressive therapies.

KW - Heart failure

KW - Left ventricular dysfunction

KW - Left ventricular hypertrophy

KW - Mortality

KW - N-terminal pro-B-type

KW - Troponin T

UR - http://www.scopus.com/inward/record.url?scp=85042159090&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042159090&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.006619

DO - 10.1161/JAHA.117.006619

M3 - Article

C2 - 29437599

AN - SCOPUS:85042159090

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 4

M1 - e006619

ER -