Estimate of ischemic stroke prevalence according to a novel 4-tiered classification of left ventricular hypertrophy: insights from the general Chinese population

Abstract

Background: Recently, a novel 4-tiered classification of left ventricular hypertrophy (LVH) based on ventricular dilatation (indexed LV end-diastolic volume [EDV]) and concentricity (mass/EDV^0.67) has improved all-cause and cardiovascular mortality risk stratification. However, their possible association with ischemic stroke has not been extensively evaluated in the general population.

Methods: We evaluated a cross-sectional study of 11,037 subjects from the general population of China in whom echocardiographic and ischemic stroke data were available to subdivide patients with LVH into four geometric patterns: indeterminate, dilated, thick and both thick and dilated hypertrophy.

Results: Compared with normal LV geometry, indeterminate and thick hypertrophy showed a higher prevalence of ischemic stroke (p < .05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115–2.398) and thick (2.143 [1.329–3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803–1.950]) and both thick and dilated hypertrophy (0.926 [0.435–1.971]) compared with normal geometry in multivariable analysis.

Conclusions: Indeterminate and thick hypertrophy were significantly associated with the presence of ischemic stroke in the general Chinese population. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy.

Key messages

• This was the first study to investigate whether a 4-tiered classification of LVH defines subgroups in the general population that are at variable risks of ischemic stroke.

• We identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy.

• The new 4-tiered categorization of LVH emerged as a valuable operational approach, a potential alternative to LVM, to refine ischemic stroke stratification in general population.

Keywords:

• Hypertrophy
• left ventricular geometry
• ischemic stroke
• echocardiography
• epidemiology
• general population

Acknowledgements

We would like to express our sincere thanks to all the authors. The authors would like to thank Dr. Yingxian Sun who was responsible for the project completion.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by grants from the “Twelfth Five-Year” project funds (National Science and Technology Support Program of China, Grant #2012BAJ18B02) and “Thirteenth Five-Year” program funds (The National Key Research and Development Program of China, Grant #2017YFC1307600).