What is the clinical evidence from this study?

Study design: Cohort. Population: Patients referred for echocardiography (n=40138). Intervention: Left ventricular mass vs. Normal left ventricular mass. Primary outcome: All-cause mortality (HR 1.21, 95% CI 1.14-1.27, p=<0.001).

September 26, 2012Open Access

Association of Left Ventricular Mass with All-Cause Mortality, Myocardial Infarction and Stroke

Q: What are the key findings of this study?

Increased left ventricular mass was independently associated with higher all-cause mortality, with a hazard ratio per 100 g increase of 1.21 in women and 1.09 in men.

Key Result

Increased left ventricular mass was independently associated with higher all-cause mortality, with a hazard ratio per 100 g increase of 1.21 in women and 1.09 in men.

Study Design

Type

Cohort (n=40,138)

Multicenter

Structured PICO

Does increased left ventricular mass predict all-cause mortality, myocardial infarction, and stroke in adult patients?

Population

40,138 adult patients (mean age 61.1 years, 52.5% female) referred for echocardiography, followed for a mean of 5.6 years.

Exposure

Increased left ventricular mass (mild, moderate, or severe) as measured by echocardiography

Comparator

Normal left ventricular mass (<163 g in women or <224 g in men)

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.21 (95% CI 1.14–1.27)

p-value: p=<0.001

Limitations

Observational design with potential for residual confounding
Body mass index and antihypertensive drugs were not accounted for
No quality control procedures to ensure comparability of left ventricular mass measurements over time
Echocardiography is less accurate than cardiac magnetic resonance imaging for estimating left ventricular mass

Abstract

BACKGROUND: Our aim was to assess the association of left ventricular mass with mortality and nonfatal cardiovascular events. METHODOLOGY/PRINCIPAL FINDINGS: Left ventricular mass was measured by echocardiography in 40138 adult patients (mean age 61.1 ± 16.4 years, 52.5% male). The primary endpoint was all-cause mortality. Secondary endpoints included nonfatal myocardial infarction and nonfatal stroke. During a mean follow-up period of 5.6 ± 3.9 years, 9181 patients died, 901 patients had a nonfatal myocardial infarction, and 2139 patients had a nonfatal stroke. Cumulative 10-year mortality was 26.8%, 31.9%, 37.4% and 46.4% in patients with normal, mildly, moderately and severely increased left ventricular mass, respectively (p<0.001). Ten-year rates of nonfatal myocardial infarction and stroke ranged from 3.2% and 6.7% in patients with normal left ventricular mass to 5.3% and 12.7% in those with severe increase in left ventricular mass, respectively. After multivariate adjustment, left ventricular mass remained an independent predictor of all-cause mortality (hazard ratio HR per 100 g increase 1.21, 95% confidence interval CI 1.14-1-27, p<0.001 in women, and HR 1.09, 95% CI 1.04-1-13, p<0.001 in men), myocardial infarction (HR 1.60, 95% CI 1.31-1.94, p<0.001 in women and HR 1.15, 95% CI 1.02-1.29, p=0.019 in men) and stroke (HR 1.26, 95% CI 1.13-1.40, p<0.001 in women and HR 1.19, 95% CI 1.09-1.30, p<0.001 in men). CONCLUSIONS/SIGNIFICANCE: Left ventricular mass has a graded and independent association with all-cause mortality, myocardial infarction and stroke.

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