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Impact of left ventricular geometry on long‐term survival in elderly men and women
Author(s) -
Selmeryd Jonas,
Sundstedt Milena,
Nilsson Göran,
Henriksen Egil,
Hedberg Pär
Publication year - 2014
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12114
Subject(s) - medicine , left ventricular hypertrophy , cardiology , hazard ratio , proportional hazards model , geometric pattern , diabetes mellitus , ejection fraction , heart failure , confidence interval , blood pressure , geometry , endocrinology , mathematics , geometric shape
Summary Background Adverse loading conditions and cardiac injury lead to remodelling of the heart into different patterns of left ventricular ( LV ) geometry. Geometry can be classified into LV hypertrophy ( LVH ), concentric remodelling ( CR ) or normal geometry ( NG ). The prognostic implications of the different geometric patterns have been extensively studied in middle‐aged subjects, but data are scarcer for elderly populations. Methods From a community‐based random sample of 75‐year‐old men and women, subjects with normal LVEF were selected ( n = 303). All‐cause and cardiovascular mortality was analysed by LV geometry with Cox regression (unadjusted and adjusted for sex, prevalent hypertension, smoking, diabetes and prevalent ischaemic heart disease). Median follow‐up time was 9·9 years. Results Prevalence of CR and LVH was 19% and 17%, respectively. Hazard ratios ( HR s) for CR were 0·93 (95% CI 0·54–1·58) for all‐cause and 1·13 (0·48–2·65) for cardiovascular mortality. HR s for LVH were 2·01 (1·30–3·10) for all‐cause and 3·55 (1·89–6·67) for cardiovascular mortality. As non‐proportionality was present in the form of an increasing hazard for LVH , we partitioned the follow‐up time at the median event time (approximately 7 years) and performed Cox regression separately within each time period. HR s for LVH during the first period were 1·23 (0·63–2·42) for all‐cause and 1·79 (0·69–4·65) for cardiovascular mortality, while HR s for the second period were 3·06 (1·73–5·41) for all‐cause and 6·60 (2·82–15·39) for cardiovascular mortality. Conclusion In this community‐based sample of 75‐year‐old men and women with normal LVEF , LVH was associated with an adverse prognosis during long‐term follow‐up, whereas CR was not.