Correspondence

Racial Differences in Heart Failure

N Engl J Med 2009; 361:92July 2, 2009

Article

To the Editor:

It is not known whether concentric hypertrophy is a common precursor to systolic dysfunction in human hypertensive heart disease.1-3 Bibbins-Domingo et al. (March 19 issue)4 report that increased left ventricular mass was associated with incident heart failure in young adults (18 to 30 years of age at baseline) in bivariate models. However, they do not report whether the increased left ventricular mass was secondary to left ventricular dilation or wall thickening and whether patients with hypertrophy in whom heart failure developed had a preserved or a reduced ejection fraction. In an elderly cohort, eccentric but not concentric hypertrophy was associated with the development of a reduced left ventricular ejection fraction.5 Therefore, it would be informative if the authors could report what fraction of patients with hypertrophy (overall and separately for concentric and eccentric hypertrophy) had systolic heart failure (with a reduced left ventricular ejection fraction or dilated cardiomyopathy at autopsy), as well as the hazard ratios associated with concentric hypertrophy and with eccentric hypertrophy for incident heart failure (overall and for systolic heart failure) in bivariate and multivariate models.

Mark H. Drazner, M.D., M.Sc.
University of Texas Southwestern Medical Center, Dallas, TX 75390-9047
mark.drazner@utsouthwestern.edu

5 References

1. 1

   Rame JE, Ramilo M, Spencer N, et al. Development of a depressed left ventricular ejection fraction in patients with left ventricular hypertrophy and a normal ejection fraction. Am J Cardiol 2004;93:234-237
   CrossRef | Web of Science | Medline

2. 2

   Drazner MH. The transition from hypertrophy to failure: how certain are we? Circulation 2005;112:936-938
   CrossRef | Web of Science | Medline

3. 3

   Berenji K, Drazner MH, Rothermel BA, Hill JA. Does load-induced ventricular hypertrophy progress to systolic heart failure? Am J Physiol Heart Circ Physiol 2005;289:H8-H16
   CrossRef | Web of Science | Medline

4. 4

   Bibbins-Domingo K, Pletcher MJ, Lin F, et al. Racial differences in incident heart failure among young adults. N Engl J Med 2009;360:1179-1190
   Full Text | Web of Science | Medline

5. 5

   Drazner MH, Rame JE, Marino EK, et al. Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: the Cardiovascular Health Study. J Am Coll Cardiol 2004;43:2207-2215
   CrossRef | Web of Science | Medline

Author/Editor Response

In our study, we found that most black patients with left ventricular hypertrophy in whom heart failure subsequently developed had eccentric, not concentric, hypertrophy, consistent with what Drazner and his colleagues have observed in older cohorts. The limited number of end points in our analysis precluded more detailed exploration of this association in the published manuscript. Analyses of the sort Drazner proposes are currently under way with the expanded number of patients with heart failure in our study.

Kirsten Bibbins-Domingo, Ph.D., M.D.
Stephen B. Hulley, M.D., M.P.H.
University of California, San Francisco, San Francisco, CA 94143