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European Journal of Echocardiography Advance Access published online on May 13, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen155
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Impact of left ventricular geometry on prognosis in hypertensive patients with left ventricular hypertrophy (the LIFE study)

Eva Gerdts1,2,*, Dana Cramariuc1,2, Giovanni de Simone3, Kristian Wachtell4, Björn Dahlöf5 and Richard B. Devereux6

1 Institute of Medicine, University of Bergen, N-5021 Bergen, Norway
2 Department of Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway
3 Department of Clinical and Experimental Medicine, Federico II University Hospital, Via S. Pansini 5, 80131 Naples, Italy
4 Department of Cardiology, Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark
5 Department of Medicine, Sahlgrenska University Hospital/Östra, 416 85 Göteborg, Sweden
6 Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, Box 22, New York, NY 10021, USA

Received 23 October 2007; accepted after revision 12 April 2008.

* Corresponding author. Tel: +47 55972220; fax: +47 55975150. E-mail address: gerdtsev{at}online.no


  Abstract

Aims: Less is known about the relation between in-treatment left ventricular (LV) geometry and risk of cardiovascular events. We assessed LV geometric patterns on baseline and annual echocardiograms as time-varying predictors of the primary composite endpoint (cardiovascular death, stroke, and myocardial infarction) in 937 hypertensive patients with LV hypertrophy during 4.8 years losartan- or atenolol-based treatment in the Losartan Intervention for Endpoint reduction in hypertension (LIFE) echocardiography substudy.

Methods and results: LV geometry was determined from LV mass/body surface area and relative wall thickness in combination. At end of the study, 52% of patients with initial LV hypertrophy had normal geometry (P < 0.001). In particular, concentric remodelling was reduced by 82% and concentric LV hypertrophy by 84%. Development of LV hypertrophy was seen in <5%. In Cox regression analyses including LV geometric patterns as time-varying variables and adjusting for treatment, Framingham risk score, race, and time-varying systolic blood pressure, the patterns independently predicted higher risk of primary composite endpoints [HR 2.99 (1.16–7.71) for concentric remodelling, HR 1.79 (1.17–2.73) for eccentric hypertrophy, and HR 2.71 (1.13–6.45) for concentric hypertrophy; all P < 0.05].

Conclusion: In hypertensive patients with ECG LV hypertrophy, in-treatment LV geometry by echocardiography adds information on risk of cardiovascular events.

Keywords: Hypertension; Left ventricular geometry; Left ventricular hypertrophy; Losartan; Atenolol


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