BACKGROUND Many conditions may affect left ventricular (LV) phenotypes which have been classified according to LV mass and geometry. There is limited data on the prognostic value of LV phenotypes classified by cardiac magnetic resonance (CMR). This study aimed to determine the prognostic value of LV phenotypes in elderly and non-elderly patients with known or suspected coronary artery disease.
METHODS This is a retrospective cohort study among patients who underwent stress or viability CMR. LV phenotypes were classified according to the LV mass index, the LV end-diastolic volume index and the LV mass/volume ratio, into normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. The primary outcome was a composite of death or heart failure.
RESULTS A total of 3289 patients was studied. The average age was 68.0 ± 12.7 years, 52.2% of patients were women. Elderly were defined as age ≥ 65 years accounting for 63.9% of the cohort. LV phenotypes were normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy at 74.5%, 5.8%, 9.2%, and 10.5%, respectively. The median duration of follow-up was 41.4 months. The composite outcome of death or heart failure occurred in 7.3% of patients. The prognostic impact of LV phenotypes was more pronounced in the elderly, with eccentric hypertrophy showing the worst prognosis, followed by concentric hypertrophy and concentric remodeling with the adjusted hazard ratio (95% CI) of 2.37 (1.72–3.25), 1.53 (1.12–2.08), and 1.14 (0.76–1.71), respectively, compared to normal phenotype. Patients with eccentric hypertrophy also demonstrated abnormal global longitudinal LV strain, left atrial strain, and extracellular volume fraction.
CONCLUSIONS LV phenotypes by CMR independently predict adverse clinical outcomes in elderly patients with known or suspected coronary artery disease. In non-elderly patients, the prognostic value of LV phenotypes was less evident. Assessment of LV phenotypes may be useful for risk stratification.
DownLoad: