Impact of Height Exponents on the Diagnosis and Prognosis of LVH: The REMODEL Study

Background: Left ventricular hypertrophy (LVH) is a strong predictor of adverse outcomes. Although normalizing LV mass (LVM) to height exponents reduced variability from body size, specific recommendations for height exponents are lacking due to a scarcity of normal cohorts to define appropriate height exponents. Objectives: The authors aimed to show the diagnostic and prognostic implications of establishing height exponents specific to sex, ethnicity, and imaging modality. Methods: Nonoverweight/nonobese Asian healthy volunteers (n = 416) were used to establish appropriate height exponents. The impact of these height exponents was examined in a separate cohort of Asian subjects with hypertension (n = 878). All individuals underwent standardized cardiovascular magnetic resonance imaging. The primary outcome was a composite of acute coronary syndrome, heart failure hospitalization, stroke, and cardiovascular mortality. Results: The height exponents for healthy female subjects and male subjects were 1.57 and 2.33, respectively. LVH was present in 27% of individuals with hypertension when indexed to body surface area and 47% when indexed to sex-specific height exponents. Most individuals reclassified to LVH with height exponents were overweight or obese. There were 37 adverse events over 60 months (37-73 months) of follow-up. Regardless of indexing method, LVH was independently associated with increased adverse events (height exponent HR: 2.80 [95% CI: 1.25-6.29; P = 0.013]; body surface area HR: 5.43 [95% CI: 2.49-11.8; P < 0.001]). Conclusions: Reference ranges specific to ethnicity, sex, and imaging modality are necessary to establish appropriate height exponents. Although using height exponents resulted in more LVH reclassification, this did not translate to a notable improvement in event prediction.