Comparison of two classification systems for left ventricular remodeling phenotyping

Abstract Background Accurate classification of left ventricular (LV) geometric remodeling is vital for clinical prognosis and guiding therapy. Traditional four-type models may fail to identify subgroups with dilated LV geometry, potentially limiting prognostic stratification. Purpose To compare the distribution of LV geometric types using both the conventional classification and the system proposed by W. Gaasch and M. Zile, and to evaluate their respective advantages and diagnostic limitations. Methods A total of 2019 patients aged 18 to 94 years (mean age 57.6 ± 16.4 years; 51% male), either healthy or with cardiovascular or respiratory pathologies, underwent transthoracic echocardiography using the Esaote MyLab Seven (Italy), following standard ASE/EACVI guidelines. LV geometry was categorized using both the classical four-type classification (based on LV mass index and relative wall thickness [RWT]) and the expanded Gaasch-Zile system (which also includes LV end-diastolic volume index [LVEDVi]). Categorical variables were presented as frequencies and percentages. Statistical analysis was performed using Statistica for Windows 13.0. Results According to the conventional classification the following distribution was observed: normal LV geometry: 53%, concentric remodeling: 10.2%, concentric hypertrophy: 15.6%, eccentric hypertrophy: 21.2%. Of those with "normal LV geometry", 25.2% demonstrated LV dilatation, suggesting a possible misclassification. According to the Gaasch-Zile classification: normal geometry: 26.9%, concentric remodeling: 10.2%, concentric hypertrophy: 12.4%, mixed hypertrophy: 3.1%, physiological/dilated hypertrophy: 11.8%, eccentric hypertrophy: 5.5%, eccentric remodeling: 11.4%; unclassified patterns amounted to 18.6% : group 1 (RWT