Progression from concentric left ventricular hypertrophy and normal ejection fraction to left ventricular dysfunction

Richard V. Milani, Mark H. Drazner, Carl J. Lavie, Daniel P. Morin, Hector O. Ventura

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Concentric left ventricular (LV) hypertrophy develops in response to a chronically increased LV afterload and is associated with increased cardiovascular events. Although the progression to systolic and diastolic heart failure is a known consequence of LV hypertrophy, few data are available on the frequency of deterioration to systolic dysfunction in patients with LV hypertrophy who originally had a normal LV ejection fraction. We evaluated the baseline and follow-up characteristics in 1,024 patients with concentric LV hypertrophy and a normal ejection fraction who had paired echocardiograms that were separated by <1 year. Systolic dysfunction occurred in 134 patients (13%) after a mean follow-up of 33 ± 24 months. The most common associated variable was interval myocardial infarction, which occurred in 43% of patients. Other risk factors for developing LV systolic dysfunction included QRS prolongation (>120 ms) and elevated follow-up arterial impedance defined as a value >4.0 mm Hg/ml/m2. Patients with either a prolonged QRS interval or an elevated follow-up arterial impedance had twice the likelihood of developing LV systolic dysfunction, and, if both factors were present, there was a greater than fourfold increased risk of developing systolic dysfunction. Blood pressure measurements alone did not adequately reflect an elevated arterial impedance. In conclusion, 13% of patients with a normal ejection fraction and concentric LV hypertrophy progress to systolic dysfunction during approximately 3 years of follow-up. The risk factors for loss of function were interval myocardial infarction, prolonged QRS, and chronically elevated arterial impedance.

Original languageEnglish (US)
Pages (from-to)992-996
Number of pages5
JournalAmerican Journal of Cardiology
Volume108
Issue number7
DOIs
StatePublished - Oct 1 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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