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Background  As heart failure ( HF )‐associated morbidity and mortality continue to escalate, enhanced focus on prevention is increasingly important. “Malignant” left ventricular (LV) hypertrophy ( LVH ):  LVH  combined with an elevated cardiac biomarker reflecting either injury (high‐sensitivity cardiac troponin T), or strain (amino‐terminal pro‐B‐type natriuretic peptide) has predicted accelerated progression to  HF . We sought to determine whether malignant  LVH  identified community‐dwelling adults initially free of cardiovascular disease at high risk of asymptomatic decline in  LV  ejection fraction or a clinical cardiovascular event.    Methods and Results  A total of 4985 of 6814 individuals without prevalent  cardiovascular disease  underwent baseline cardiac magnetic resonance for  LVH  in combination with measurement of plasma high‐sensitivity cardiac troponin T and amino‐terminal pro‐B‐type natriuretic peptide as part of MESA (Multi‐Ethnic Study of Atherosclerosis) and were subsequently divided into 4 groups: (1) No  LVH , no elevated biomarkers (n=2206; 44.3%); (2) No  LVH , ≥1 elevated biomarkers (n=2275; 45.7%); (3)  LVH , no elevated biomarkers (n=153; 3.0%); and (4)  LVH , ≥1 elevated biomarkers (malignant  LVH ; n=351; 7.0%).  Cardiac magnetic resonance  was repeated 10 years later (n=2831) for assessment of  LV ejection fraction  <50%. Median follow‐up was 12.2 years. Malignant  LVH  was associated with 7.0‐, 3.5‐, and 2.6‐fold adjusted increases in incidence of  HF ,  cardiovascular  death, and asymptomatic  LV  dysfunction, respectively, versus group 1. New‐onset  HF  was predominately  HF  with reduced ejection fraction (9.5‐fold increase).    Conclusions  Malignant  LVH  is predictive of progression to asymptomatic  LV  dysfunction,  HF  (particularly  HF  with reduced ejection fraction), and  cardiovascular  death. Consequently, malignant  LVH  represents a high‐risk phenotype among individuals without known  cardiovascular disease , which should be targeted for increased surveillance and more‐aggressive therapies.

journal of the american heart association

“Malignant” Left Ventricular Hypertrophy Identifies Subjects at High Risk for Progression to Asymptomatic Left Ventricular Dysfunction, Heart Failure, and Death: MESA (Multi‐Ethnic Study of Atherosclerosis)