Prognostic implications of left ventricular hypertrophy defined by the thresholds from the international and Chinese guidelines

Dan Zhou; Mengqi Yan; Anping Cai; Qiu Xie; Qi Cheng; Songtao Tang; Yingqing Feng

doi:10.1111/jch.14687

Prognostic implications of left ventricular hypertrophy defined by the thresholds from the international and Chinese guidelines

J Clin Hypertens (Greenwich). 2023 Jul;25(7):628-637. doi: 10.1111/jch.14687. Epub 2023 Jun 19.

Authors

Dan Zhou¹, Mengqi Yan¹, Anping Cai^{1

2}, Qiu Xie^{1

2}, Qi Cheng¹, Songtao Tang³, Yingqing Feng^{1

2}

Affiliations

¹ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
² Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
³ Department of Internal Medicine, Community Health Center of Liao Bu Community, Dongguan, People's Republic of China.

Abstract

To compare the predictive value of mortality between left ventricular hypertrophy (LVH) defined by Chinese thresholds and defined by international guidelines in hypertension individuals and investigate better indexation methods for LVH in Chinese population. We included 2454 community hypertensive patients with Left ventricular mass (LVM) and relative wall thickness. LVM was indexed to body surface area (BSA), height² ⁷ and height ¹ ⁷ . The outcomes were all-cause and cardiovascular mortality. Cox proportional hazards models were used to explore the association between LVH and the outcomes. C-statistics and time-dependent receiver operating characteristic curve (ROC) was used to evaluate the value of those indicators. During a median follow-up of 49 months (interquartile range 2-54 months), 174 participants (7.1%) died from any cause (n = 174), with 71 died of cardiovascular disease. LVM/BSA defined by the Chinese thresholds was significantly associated with cardiovascular mortality (HR: 1.63; 95%CI: 1.00-2.64). LVM/BSA was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.56; 95%CI: 1.14-2.14) and using Guideline thresholds (HR: 1.52; 95%CI: 1.08-2.15). LVM/Height^1.7 was significantly associated with all-cause mortality using Chinese thresholds (HR: 1.60; 95%CI: 1.17-2.20) and using Guideline thresholds (HR: 1.54; 95%CI: 1.04-2.27). LVM/Height^2.7 was not significantly associated with all-cause mortality. C-statistics indicated that LVM/BSA and LVM/Height^1.7 by Chinese thresholds had better predictive ability for mortality. Time-ROC indicated that only LVM/Height^1.7 defined by Chinese threshold had incremental value for predicting mortality. We found that in community hypertensive populations, race-specific thresholds should be used to classify LV hypertrophy related to mortality risk stratification. LVM/BSA and LVM/Height^1.7 are acceptable normalization method in Chinese hypertension.

Keywords: Chinese threshold; all-cause mortality; cardiovascular mortality; guideline thresholds; left ventricular hypertrophy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / etiology
Humans
Hypertension* / complications
Hypertension* / epidemiology
Hypertrophy, Left Ventricular
Prognosis
ROC Curve