Identifying Appropriate Height Exponents and the Impact on Diagnosis and Prognosis of Left Ventricular Hypertrophy: 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. We aimed to demonstrate the diagnostic and prognostic implications of establishing height exponents specific to sex, ethnicity and imaging modality. METHODS Non-overweight/non-obese 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 Asians with hypertension (n=878). All individuals underwent standardized cardiovascular magnetic resonance. Primary outcome was a composite of acute coronary syndrome, heart failure hospitalization, stroke, and cardiovascular mortality. RESULTS The height exponents for healthy females and males were 1.57 and 2.33, respectively. LVH was present in 27% of individuals with hypertension when indexed to body surface area (BSA) 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 (37-73) months of follow-up. Regardless of indexing method, LVH was independently associated with increased adverse events ( height exponent hazard ratio (HR) : 2.8 [1.25-6.29], P=0.013; BSA HR : 5.43 [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 utilising height exponents resulted in more LVH reclassification, this did not translate to a notable improvement in event prediction. ![Figure][1] Graphical Abstract In this cardiovascular magnetic resonance study, the appropriate height exponents were 1.57 in Asian females and 2.33 in Asian males. Normalizing to height exponents increased the diagnosis of hypertensive left ventricular hypertrophy (LVH), predominantly in those who were overweight and obese. Regardless of the method of indexing, LVH was associated with adverse primary and secondary outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NCT02670031 ### Funding Statement The study is funded by the National Medical Research Council of Singapore ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the SingHealth Centralized Institutional Review Board I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data will be available upon reasonable request to the corresponding author * ACS : Acute Coronary Syndrome BMI : Body Mass Index BSA : Body Surface Area CMR : Cardiovascular Magnetic Resonance HF : Heart Failure LVH : Left Ventricular Hypertrophy LVM : Left Ventricular Mass SBP : Systolic Blood Pressure [1]: pending:yes