DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Background: Constant exposure to cardiovascular (CV) risk factors and adverse hemodynamic conditions induce complex changes in left ventricular (LV) geometry.
Aim: To assess the association of LV geometry with myocardial work in a well-characterized population-based sample of individuals free from HF.
Methods and results: The Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study comprehensively characterized a representative sample of the population of Würzburg, Germany, aged 30-79 years. 1926 individuals were studied (49.3% female, aged 54±12 years), who were in sinus rhythm and free from significant valvular disease. Using echocardiography- based MyW analysis, global work index (GWI), constructive (GCW) and wasted work (GWW) and global work efficiency (GWE) were determined. We defined four subgroups according to LV mass index (LVMi; normal: ≤95 g/m2 in women or ≤115 g/m2 in men) and LV relative wall thickness (RWT; normal ≤0.42)(Figure): 1) normal LV geometry: LVMi and RWT within normal range; 2) concentric LV remodelling (CR): normal LVMi but RWT >0.42; 3) concentric LV hypertrophy (CH): increased LVMi and RWT; eccentric LV hypertrophy (EH): increased LVMi but normal RWT.
Compared to participants with abnormal geometric LV patterns, participants with normal LV geometry were younger and had lower values for body mass index (BMI), systolic blood pressure, LDL cholesterol, HbA1c, NT-proBNP, LVEF, and global longitudinal strain (table). Any deviation from normal LV geometry was associated with altered MyW resulting in lower work efficiency. On the other hand, CR and CH were characterized by higher amount of GWI and GWE, but also inappropriately high GWW, EH was characterized by lower GCW (table, figure).
Conclusion In a population-based sample of individuals free from heart failure, abnormal LV geometry was associated with an unfavourable CV risk factor and comorbidity profile. The different alterations in LV geometry were associated with different MyW patterns, but all resulted in lower GWE.
Table. Baseline characteristics
|
|
LV normal geometry N=1789 |
LV concentric remodelling N=100 |
LV concentric hypertrophy N=6 |
LV eccentric hypertrophy N=31 |
|
Age [years] |
53 (12) |
61 (10) * |
69 (16) * |
61 (9) * |
|
Women |
879 (49) |
48 (48) |
4 (67) |
19 (61) |
|
BMI [kg/m2]; |
26 (4) |
28 (5) * |
30 (9) |
28 (5) * |
|
SBP [mmHg] |
130 (17) |
141 (18) * |
148 (12) * |
139 (23) * |
|
LVEF [%] |
61 (4) |
60 (4) * |
59 (3) |
58 (7) * |
|
GLS (– %) |
21 (3) |
20 (2) * |
21 (1) |
19 (3) * |
|
RWT |
0.33 (0.05) |
0.45 (0.04) |
0.44 (0.02) |
0.35 (0.04) |
|
LVMi [g/m2] |
71 (15) |
78 (15) |
113 (13) |
112 (10) |
|
GCW [mmHg%] |
2501 (424) |
2575 (457) |
2965 (240) * |
2445 (526) |
|
GWW [mmHg%] |
81 (58, 118) |
98 (68, 133) * |
130 (80, 191) |
117 (90, 158) * |
|
GWI [mmHg%] |
2276 (392) |
2311 (424) |
2670 (315) * |
2207 (502) |
|
GWE [%] |
96 (95, 97) |
95 (94, 97) * |
94 (91, 96) |
94 (93, 95) * |
Data are n (%), mean (SD), or median (interquartile range).
*p<0.05 compared to LV normal geometryBMI=body mass index, SBP=systolic blood pressure, LVEF=left ventricular ejection fraction, GLS=global longitudinal strain, RWT=relative wall thickness, LVMi=left ventricular mass index, GCW=global constructive work, GWW=global wasted work, GWI=global work index, GWE=global work efficiency
Figure
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