Left ventricular mass-to-strain ratio to predict treatment response and prognosis in hypertensive heart disease
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Background
Typical hypertensive heart disease (HHD) phenotype is the left ventricular hypertrophy (LVH) and dysfunction, measurable via LV global longitudinal strain. We aimed to evaluate the LV mass-to-strain ratio (LV-MSR) as a marker of HHD treatment response and prognosis.
Methods
We retrospectively analyzed consecutive patients who underwent echocardiography at hypertension diagnosis and 6–18-monthly intervals in tertiary centers from 2006–2021. Association between LV-MSR and LV geometry changes was assessed using receiver operating characteristic (ROC) analysis and multivariable logistic regression. Time-dependent ROC and Cox regression were performed to evaluate LV-MSR prognostic value for cardiovascular death and heart failure hospitalization.
Results
Among 1,600 patients (mean age, 65.1 years; 61.1% male), 23.4% had concentric LVH, and 21.5% eccentric LVH at baseline. LV-MSR had the highest predictive accuracy for LV geometry changes (area-under-the-curve 0.786; 95% confidence interval [CI] 0.759– 0.813). LV-MSR showed significant association with new-onset LVH among the non-LVH group (adjusted odds ratio, 1.125, 95%CI 1.054–1.200, P<0.001) and persistent LVH among LVH group (adjusted hazard ratio [aHR] 1.133, 95%CI 1.087–1.180, P<0.001) at baseline. Higher LV-MSR was an independent prognosticator, whether as a continuous (aHR 1.032 per +1 g/m 2 /%, 95%CI 1.015–1.049, P<0.001) or categorical variable (aHR 2.257 for LV-MSR ≥6.52 g/m 2 /%, 95%CI 1.463–3.480, P<0.001). The associations persisted in subgroup analyses according to the presence of LVH baseline.
Conclusions
LV-MSR independently predicts LV geometry changes and clinical outcomes in HHD, serving as a superior prognostic marker compared to LV mass index or LV-GLS alone.
Clinical Perspective
What is new?
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LV mass-to-strain ratio (LV-MSR) integrates LV geometry (LVH) and LV longitudinal function (LV-GLS), providing a more comprehensive assessment of hypertensive heart disease (HHD) than either parameter alone.
What are the clinical implications?
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Higher LV-MSR predicts LVH progression, persistence, and worse clinical outcomes, making it a useful marker for risk stratification and treatment response assessment in hypertension.
Research Perspective
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Further studies should validate LV-MSR across diverse populations, integrate it into standard echocardiographic protocols, and evaluate its role in clinical decision-making and antihypertensive treatment guidance to improve patient outcomes.
