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

TY - JOUR

T1 - Impact of Height Exponents on the Diagnosis and Prognosis of LVH

T2 - The REMODEL Study

AU - Lee, Clement

AU - Chan, Ryan

AU - Toh, Desiree Faye

AU - Kui, Michelle

AU - Lee, Vivian

AU - Bryant, Jennifer A.

AU - Boubertakh, Redha

AU - Lee, Chi Hang

AU - Le, Thu Thao

AU - Chin, Calvin W.L.

N1 - Publisher Copyright: © 2025 The Authors

PY - 2025/3/4

Y1 - 2025/3/4

N2 - 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.

AB - 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.

KW - allometric scaling

KW - cardiovascular magnetic resonance imaging

KW - left ventricular hypertrophy

UR - https://www.scopus.com/pages/publications/85218169527

U2 - 10.1016/j.jacasi.2024.12.006

DO - 10.1016/j.jacasi.2024.12.006

M3 - Article

C2 - 40049926

AN - SCOPUS:85218169527

VL - 5

SP - 350

EP - 357

JO - JACC: Asia

JF - JACC: Asia

IS - 3P1

ER -