Left ventricular hypertrophy and risk reclassification for coronary events in multi-ethnic adults

Sandip K Zalawadiya; Prasad C Gunasekaran; Chirag P Bavishi; Vikas Veeranna; Sidakpal Panaich; Luis Afonso

doi:10.1177/2047487314530383

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Left ventricular hypertrophy and risk reclassification for coronary events in multi-ethnic adults

Journal article

Open access

Peer reviewed

Left ventricular hypertrophy and risk reclassification for coronary events in multi-ethnic adults

Sandip K Zalawadiya, Prasad C Gunasekaran, Chirag P Bavishi, Vikas Veeranna, Sidakpal Panaich and Luis Afonso

European journal of preventive cardiology, Vol.22(5), pp.673-679

05/2015

DOI: 10.1177/2047487314530383

PMID: 24699336

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Abstract

Left ventricular hypertrophy (LVH) has not been evaluated for reclassification improvement in the intermediate Framingham risk category for incident hard coronary events in a large multi ethnic population free of cardiovascular disease at baseline. A post-hoc analysis on the Multi Ethnic Study of Atherosclerosis (MESA) dataset (n = 4921) was performed. LVH was defined as the upper 95 th percentile of cardiac magnetic resonance imaging derived left ventricular mass (LVM) indexed based on body surface area (BSA) and height. Multivariate Cox proportional hazards models were used to assess the independent association between LVH and composite outcomes like all cardiovascular disease (CVDa) and hard coronary heart disease (CHDh) events over a mean follow-up period of 4.5 years. To assess the incremental value of LVH over traditional CV risk factors for CHDh prediction, we compared the discrimination, calibration and net reclassification index (NRI) of models comprising of traditional CV risk factors with and without LVH. LVH derived from LVM indexed by BSA (LVH-BSA) and height(1.7)(LVH-height) showed an independent association with CVDa (LVH-BSA: hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.05-2.20, p = 0.03; LVH-height(1.7): HR 1.58, 95% CI 1.14-2.18, p = 0.012) and CHDh (LVH-BSA: HR 2.36, 95% CI 1.37-4.04, p = 0.002; LVH-height(1.7): HR: 1.95, 95% CI: 1.17-3.26, p = 0.01). Addition of LVH to the model based on traditional CV risk factors demonstrated no significant improvement in NRI for CHDh in either the entire cohort (LVH-BSA: NRI 1.7%, 95% CI: -8.3% to 11.7%, p = 0.74; LVH-height(1.7): NRI 2.7%, 95% CI: -5.8% to 11.3%, p = 0.62) or the intermediate risk group (LVH-BSA: NRI 12.0%, 95% CI: -5.7% to 29.8%, p = 0.19; LVH-height(1.7): NRI 14.5%, 0.1% to 28.8%, p = 0.05). Although an independent predictor of cardiovascular events, LVH does not lead to clinically meaningful reclassification of the overall and intermediate risk population for CHDh.

Humans

Middle Aged

Risk Factors

Coronary Disease - epidemiology

Female

Male

Aged

Hypertrophy, Left Ventricular - ethnology

Details

Title: Subtitle: Left ventricular hypertrophy and risk reclassification for coronary events in multi-ethnic adults
Creators: Sandip K Zalawadiya - Department of Internal Medicine, Wayne State University, USA
Prasad C Gunasekaran - Department of Internal Medicine, Wayne State University, USA
Chirag P Bavishi - Department of Internal Medicine, St Luke's Roosevelt Hospital Center, USA
Vikas Veeranna - Department of Internal Medicine, Wayne State University, USA
Sidakpal Panaich - Department of Internal Medicine, Wayne State University, USA
Luis Afonso - Department of Internal Medicine, Wayne State University, USA lafonso@med.wayne.edu
Resource Type: Journal article
Publication Details: European journal of preventive cardiology, Vol.22(5), pp.673-679
DOI: 10.1177/2047487314530383
PMID: 24699336
NLM abbreviation: Eur J Prev Cardiol
ISSN: 2047-4873
eISSN: 2047-4881
Language: English
Date published: 05/2015
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094572202771

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