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The remodelling index risk stratifies patients with hypertensive left ventricular hypertrophy.

  • Le, Thu-Thao1, 2
  • Lim, Vanessa1
  • Ibrahim, Rositaa1, 3
  • Teo, Muh-Tyng1
  • Bryant, Jennifer1
  • Ang, Briana1
  • Su, Boyang1
  • Aw, Tar-Choon4
  • Lee, Chi-Hang1
  • Bax, Jeroen5
  • Cook, Stuart1, 2
  • Chin, Calvin W L1, 2
  • 1 Department of Cardiology, National Heart Center Singapore, Singapore. , (Singapore)
  • 2 Cardiovascular ACP, Duke-NUS Medical School, Singapore. , (Singapore)
  • 3 Department of Radiology, Penang General Hospital, Penang, Malaysia. , (Malaysia)
  • 4 Department of Laboratory Medicine, Changi General Hospital, Singapore. , (Singapore)
  • 5 Faculty in Medicine, Leiden University, the Netherlands. , (Netherlands)
Published Article
European Heart Journal - Cardiovascular Imaging
Oxford University Press
Publication Date
Apr 07, 2020
DOI: 10.1093/ehjci/jeaa040
PMID: 32255186


Hypertensive left ventricular hypertrophy (LVH) is associated with increased cardiovascular events. We previously developed the remodelling index (RI) that incorporated left ventricular (LV) volume and wall-thickness in a single measure of advanced hypertrophy in hypertensive patients. This study examined the prognostic potential of the RI in reference to contemporary LVH classifications. Cardiovascular magnetic resonance was performed in 400 asymptomatic hypertensive patients. The newly derived RI (EDV3t, where EDV is LV end-diastolic volume and t is the maximal wall thickness across 16 myocardial segments) stratified hypertensive patients: no LVH, LVH with normal RI (LVHNormal-RI), and LVH with low RI (LVHLow-RI). The primary outcome was a composite of all-cause mortality, acute coronary syndromes, strokes, and decompensated heart failure. LVHLow-RI was associated with increased LV mass index, fibrosis burden, impaired myocardial function and elevated biochemical markers of myocardial injury (high-sensitive cardiac troponin I), and wall stress. Over 18.3 ± 7.0 months (601.3 patient-years), 14 adverse events occurred (2.2 events/100 patient-years). Patients with LVHLow-RI had more than a five-fold increase in adverse events compared to those with LVHNormal-RI (11.6 events/100 patient-years vs. 2.0 events/100 patient-years, respectively; log-rank P < 0.001). The RI provided incremental prognostic value over and above a model consisting of clinical variables, LVH and concentricity; and predicted adverse events independent of clinical variables, LVH, and other prognostic markers. Concentric and eccentric LVH were associated with adverse prognosis (log-rank P = 0.62) that was similar to the natural history of hypertensive LVH (5.1 events/100 patient-years). The RI provides prognostic value that improves risk stratification of hypertensive LVH. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

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