Journal Article Ahead of print
PubMed: 42544038 DOI: 10.1093/ehjci/jeag203
Prevalence and Determinants of Asymmetric Septal Hypertrophy (ASH) in Diseases of Left Ventricular Hypertrophy (LVH).
Eur Heart J Cardiovasc Imaging
Authors: Hunain Shiwani, Joao Augusto, Constantin-Cristian Topriceanu, Adam Ioannou, Stefania Rosmini, Viviana Maestrini, Rebecca Hughes, Kristopher Knott, Anish Bhuva, Benjamin Dowsing, Jessica Artico, Iain Pierce, Thomas Treibel, James Howard, Charlotte Manisty, Peter Kellman, Rebecca Kozor, Richard Steeds, Gabriella Captur, Saidi Mohiddin, Luis Lopes, Marianna Fontana, James Moon, Rhodri Davies
Affiliations
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK.
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, UK.
- Division of Medicine, Royal Free Hospital, University College London, London, UK.
- Kings College Hospital, Denmark Hill, London.
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
- National Heart and Lung Institute, Imperial College London, London, UK.
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, Maryland, USA.
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
- MRC Unit of Lifelong Health and Ageing, University College London, 1-19 Torrington Place, Fitzrovia, London, UK.
- Inherited Heart Muscle Conditions Clinic, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, UK.
Abstract
AIMS
To determine the prevalence of asymmetric septal hypertrophy(ASH) across health and in diseases associated with left ventricular hypertrophy(LVH), including hypertrophic cardiomyopathy(HCM).
METHODS AND RESULTS
We analysed two complementary datasets. First, a large UK Biobank healthy reference cohort(n = 4,020) was used to model demographic determinants of septal-to-lateral wall thickness ratio(SLR) and to provide the reference group for age-, sex-, and body-surface area-adjusted comparisons. Second, a multi-cohort clinical CMR dataset included 1,655 subjects comprising local healthy volunteers, athletes, patients with hypertension, aortic stenosis, Fabry disease, AL amyloidosis, ATTR amyloidosis, and HCM. LVH was defined by maximum wall thickness(MWT) ≥ 15 mm and asymmetry defined as SLR≥1.3. Left ventricular morphology was classified as normal, asymmetric remodelling(SLR≥1.3;MWT<15 mm), symmetric hypertrophy(SLR<1.3;MWT≥15 mm) or ASH(SLR≥1.3;MWT≥15 mm). ASH was highly prevalent in HCM(61%) but was also observed in ATTR amyloidosis(37%), AS(26%), and AL amyloidosis(23%). In the healthy reference cohort, a higher septal-to-lateral ratio was independently associated with older age, female sex, and larger BSA(p < 0.001). After adjustment for these demographic factors, only HCM retained a clinically meaningful excess in septal asymmetry(ΔSLR=+0.27;p < 0.001). In contrast, the apparent asymmetry in non-HCM cohorts was partly explained by demographic variation. After adjustment, only HCM showed a clinically meaningful excess in SLR, whereas other disease cohorts showed either no material difference or small negative differences relative to healthy controls.
CONCLUSION
ASH is a common but non-specific finding in diseases associated with LVH. Septal asymmetry increases with age and body-size and is more pronounced in women. After adjusting for age, sex, and body-size, disproportionate septal asymmetry was most characteristic of HCM.
MeSH
Hypertrophy, Left Ventricular, Hypertrophy, Cardiomyopathy, Hypertrophic, Amyloidosis, Prevalence, Sex, Demography