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Relation of Concentric Remodeling to Adverse Outcomes in Patients With Stable Coronary Artery Disease (from the Heart and Soul Study)

      Concentric remodeling (CR) is defined as increased left ventricular (LV) wall thickness with normal total LV mass. When encountered in populations with hypertension or patients undergoing aortic valve replacement, some studies have shown that CR predicts cardiovascular (CV) events and stroke. To expand our understanding of the prognostic implications of this common echocardiographic finding, we examined the association of CR and adverse CV events in ambulatory patients with coronary artery disease (CAD). We tested the hypothesis that finding CR on echocardiogram in ambulatory CAD independently predicts heart failure hospitalizations and CV death. Transthoracic echocardiograms were recorded in 973 participants from the Heart and Soul Study. Participants were divided into 4 groups: normal, CR, concentric LV hypertrophy, and eccentric LV hypertrophy. CV events were determined by 2 independent adjudicators and these were analyzed by Cox proportional hazards models. After mean 4.9 ± 1.5 years of follow-up, adverse outcomes occurred more frequently in those with concentric and eccentric LV hypertrophy but not in those with CR. After multivariate adjustment, concentric and eccentric LV hypertrophies were associated with increased risk of death and heart failure hospitalization, whereas CR was not. In conclusion, our hypothesis was not supported because CR was not associated with adverse CV events in our cohort of patients with stable CAD.
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      References

        • Grossman W.
        • Jones D.
        • McLaurin L.P.
        Wall stress and patterns of hypertrophy in the human left ventricle.
        J Clin Invest. 1975; 56: 56-64
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Bluemke D.A.
        • Kronmal R.A.
        • Lima J.A.
        • Liu K.
        • Olson J.
        • Burke G.L.
        • Folsom A.R.
        The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study.
        J Am Coll Cardiol. 2008; 52: 2148-2155
        • Di Tullio M.R.
        • Zwas D.R.
        • Sacco R.L.
        • Sciacca R.R.
        • Homma S.
        Left ventricular mass and geometry and the risk of ischemic stroke.
        Stroke. 2003; 34: 2380-2384
        • Muiesan M.L.
        • Salvetti M.
        • Monteduro C.
        • Bonzi B.
        • Paini A.
        • Viola S.
        • Poisa P.
        • Rizzoni D.
        • Castellano M.
        • Agabiti-Rosei E.
        Left ventricular concentric geometry during treatment adversely affects cardiovascular prognosis in hypertensive patients.
        Hypertension. 2004; 43: 731-738
        • Pierdomenico S.D.
        • Lapenna D.
        • Bucci A.
        • Manente B.M.
        • Cuccurullo F.
        • Mezzetti A.
        Prognostic value of left ventricular concentric remodeling in uncomplicated mild hypertension.
        Am J Hypertens. 2004; 17: 1035-1039
        • Verdecchia P.
        • Schillaci G.
        • Borgioni C.
        • Ciucci A.
        • Battistelli M.
        • Bartoccini C.
        • Santucci A.
        • Santucci C.
        • Reboldi G.
        • Porcellati C.
        Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass.
        J Am Coll Cardiol. 1995; 25: 871-878
        • Duncan A.I.
        • Lowe B.S.
        • Garcia M.J.
        • Xu M.
        • Gillinov A.M.
        • Mihaljevic T.
        • Koch C.G.
        Influence of concentric left ventricular remodeling on early mortality after aortic valve replacement.
        Ann Thorac Surg. 2008; 85: 2030-2039
        • Ruo B.
        • Rumsfeld J.S.
        • Hlatky M.A.
        • Liu H.
        • Browner W.S.
        • Whooley M.A.
        Depressive symptoms and health-related quality of life: the Heart and Soul Study.
        JAMA. 2003; 290: 215-221
        • Quinones M.A.
        • Waggoner A.D.
        • Reduto L.A.
        • Nelson J.G.
        • Young J.B.
        • Winters Jr, W.L.
        • Ribeiro L.G.
        • Miller R.R.
        A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography.
        Circulation. 1981; 64: 744-753
        • Cheitlin M.D.
        • Alpert J.S.
        • Armstrong W.F.
        • Aurigemma G.P.
        • Beller G.A.
        • Bierman F.Z.
        • Davidson T.W.
        • Davis J.L.
        • Douglas P.S.
        • Gillam L.D.
        • Lewis R.P.
        • Pearlman A.S.
        • Philbrick J.T.
        • Shah P.M.
        • Williams R.G.
        • Ritchie J.L.
        • Eagle K.A.
        • Gardner T.J.
        • Garson A.
        • Gibbons R.J.
        • O'Rourke R.A.
        • Ryan T.J.
        • Developed in collaboration with the American Society of Echocardiography
        ACC/AHA guidelines for the clinical application of echocardiography: executive summary.
        J Am Coll Cardiol. 1997; 29: 862-879
        • Schiller N.B.
        • Shah P.M.
        • Crawford M.
        • DeMaria A.
        • Devereux R.
        • Feigenbaum H.
        • Gutgesell H.
        • Reichek N.
        • Sahn D.
        • Schnittger I.
        Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Luepker R.V.
        • Apple F.S.
        • Christenson R.H.
        • Crow R.S.
        • Fortmann S.P.
        • Goff D.
        • Goldberg R.J.
        • Hand M.M.
        • Jaffe A.S.
        • Julian D.G.
        • Levy D.
        • Manolio T.
        • Mendis S.
        • Mensah G.
        • Pajak A.
        • Prineas R.J.
        • Reddy K.S.
        • Roger V.L.
        • Rosamond W.D.
        • Shahar E.
        • Sharrett A.R.
        • Sorlie P.
        • Tunstall-Pedoe H.
        Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute.
        Circulation. 2003; 108 (2543–2539)
        • Hees P.S.
        • Fleg J.L.
        • Lakatta E.G.
        • Shapiro E.P.
        Left ventricular remodeling with age in normal men versus women: novel insights using three-dimensional magnetic resonance imaging.
        Am J Cardiol. 2002; 90: 1231-1236
        • Gruner Svealv B.
        • Fritzon G.
        • Andersson B.
        Gender and age related differences in left ventricular function and geometry with focus on the long axis.
        Eur J Echocardiogr. 2006; 7: 298-307
        • Turakhia M.P.
        • Schiller N.B.
        • Whooley M.A.
        Prognostic significance of increased left ventricular mass index to mortality and sudden death in patients with stable coronary heart disease (from the Heart and Soul Study).
        Am J Cardiol. 2008; 102: 1131-1135
        • Rossi M.A.
        Pathologic fibrosis and connective tissue matrix in left ventricular hypertrophy due to chronic arterial hypertension in humans.
        J Hypertens. 1998; 16: 1031-1041
        • Gardin J.M.
        • McClelland R.
        • Kitzman D.
        • Lima J.A.
        • Bommer W.
        • Klopfenstein H.S.
        • Wong N.D.
        • Smith V.E.
        • Gottdiener J.
        M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study).
        Am J Cardiol. 2001; 87: 1051-1057
        • Ghali J.K.
        • Liao Y.
        • Cooper R.S.
        Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease.
        J Am Coll Cardiol. 1998; 31: 1635-1640
        • McManus D.D.
        • Shah S.J.
        • Fabi M.R.
        • Rosen A.
        • Whooley M.A.
        • Schiller N.B.
        Prognostic value of left ventricular end-systolic volume index as a predictor of heart failure hospitalization in stable coronary artery disease: data from the Heart and Soul Study.
        J Am Soc Echocardiogr. 2009; 22: 190-197