Prognosis associated with geometric patterns of left ventricular remodeling: systematic review and network meta-analysis

Background: There are four geometric patterns (normal geometry, concentric remodeling, concentric and eccentric hypertrophy) used to describe cardiac remodeling. Although left ventricular hypertrophy(LVH) is associated with adverse prognosis, the incremental prognostic value of geometric patterns is less certain. We examined characteristics and prognosis associated with the four conventional patterns of left ventricle (LV) remodeling. Methods: A comprehensive literature search was performed on MEDLINE/PubMed, Embase and the Cochrane Library until January 2019. Network meta-analysis was used to pool data from direct and indirect prognostic comparisons of the four geometric patterns. All-cause mortality was defined as the study outcome. Results: A total of 22 echocardiographic studies (76,142 individuals; 50.1% males; 64.4±7.9 years) of diverse cardiovascular diseases were included. Concentric LVH was associated with the highest prevalence of cardiovascular risk factors and diseases; and eccentric hypertrophywas associated with a high prevalence of atrial fibrillation and low LV ejection fraction. Compared to normal geometry, the risk of all-cause mortality was increased in concentric hypertrophy(risk ratio 1.97 [95% confidence interval 1.63-2.39]) but similar to eccentric hypertrophy(risk ratio 1.15 [95% confidence interval 0.97-1.36]). Conclusions: The study populations examined in the meta-analysis were heterogeneous. Concentric LVH conferred the highest risk of all-cause mortality that overlapped with eccentric hypertrophy. Strategies to improve LVH risk stratification should be examined in future research.