Left Ventricular Mass-to-Strain Ratio to Predict Change in Left Ventricular Hypertrophy and Prognosis in Hypertensive Heart Disease

Abstract

BACKGROUND: A typical hypertensive heart disease phenotype is the left ventricular hypertrophy (LVH) and dysfunction, measurable via LV mass and global longitudinal strain. We aimed to evaluate the LV mass-to-strain ratio (LV-MSR) as a marker of the clinical course in patients with hypertensive heart disease. METHODS: We retrospectively analyzed consecutive patients who underwent echocardiography at the time of hypertension diagnosis and at 6- to 18-month intervals in tertiary centers from 2006 to 2021. Associations of LV-MSR with LVH changes and clinical outcomes (cardiovascular death and heart failure hospitalization occurring after the second echocardiogram) were assessed using time-dependent receiver-operating characteristic analysis and multivariable Cox regression. RESULTS: Among 1600 patients (mean age 65.1years; 61.1% male), 23.4% had concentric LVH, and 21.5% had eccentric LVH at baseline. The median interval between echocardiograms was 10.2months (interquartile range, 6.8–13.4). LV-MSR showed the highest discriminatory value for LVH changes (area under the curve, 0.726 [95% CI, 0.685–0.760]), outperforming LV mass index (area under the curve, 0.690 [95% CI 0.648–0.728]; P<0.001) and LV-global longitudinal strain (area under the curve, 0.600 [95% CI 0.558–0.647]; P<0.001). Higher LV-MSR was significantly associated with new-onset LVH (global test P<0.001) and persistent LVH (global test P<0.001). LV-MSR was an independent prognosticator, both as a continuous (adjusted hazard ratio [HR], 1.044 per +1g/m2 per % [95% CI 1.020–1.069]) or categorical variable (adjusted HR 2.267 for LV-MSR, ≥6.52g/m2 per % [95% CI 1.520–3.381]). These associations remained consistent across subgroups by sex and baseline LVH status. CONCLUSIONS: LV-MSR independently predicts LVH changes and clinical outcomes in hypertensive heart disease, serving as a superior prognostic marker compared with LV mass index or LV-global longitudinal strain alone.