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Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study
P Verdecchia1, G Carini, A Circo
1ANMCO Research Center, Via La Marmora, 36, Firenze, Italy. verdec@tin.it
Insights
Elevated left ventricular (LV) mass in individuals with essential hypertension independently predicts increased cardiovascular events. This large multicenter study confirms LV mass as a crucial prognostic marker for cardiovascular risk.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Limited evidence exists on the prognostic significance of left ventricular (LV) mass in uncomplicated essential hypertension.
- Existing studies are primarily single-center and lack extensive validation.
Purpose of the Study:
- To investigate the prognostic value of left ventricular (LV) mass measured by echocardiography in subjects with uncomplicated essential hypertension.
- To establish LV mass as a predictor of cardiovascular events in a large, multicenter cohort.
Main Methods:
- Prospective, multicenter study (MAssa Ventricolare sinistra nell'Ipertensione) involving 45 centers.
- Inclusion criteria: essential hypertension, no prior cardiovascular events, age >= 50.
- Centralized reading of echocardiographic data and tailored treatment protocols.
Main Results:
- 1,033 subjects were followed for a median of 3 years.
- Cardiovascular event rates were significantly higher in subjects with LV mass > or = 125 g/m(2) (3.2 per 100 patient-years) compared to normal LV mass (1.3 per 100 patient-years).
- LV hypertrophy independently associated with a 2.08-fold increased risk of events (95% CI: 1.22-3.57) after adjusting for risk factors. Each 1 SD increase in LV mass correlated with a 40% rise in cardiovascular event risk.
Conclusions:
- A strong, continuous, and independent relationship exists between LV mass and subsequent cardiovascular morbidity in uncomplicated essential hypertension.
- This study provides the first large-scale, nationwide, multicenter evidence supporting LV mass as a significant prognostic indicator in this population.
Objectives:
This study investigated the prognostic value of left ventricular (LV) mass at echocardiography in uncomplicated subjects with essential hypertension.
Background:
Only a few single-center studies support the prognostic value of LV mass in uncomplicated hypertension.
Methods:
The MAssa Ventricolare sinistra nell'Ipertensione study was a multicenter (45 centers) prospective study. The prespecified aim was to explore the prognostic value of LV mass in hypertension. Admission criteria included essential hypertension, no previous cardiovascular events, and age > or =50. There was central reading of echocardiographic tracings. Treatment was tailored to the single subject.
Results:
Overall, 1,033 subjects (396 men) were followed for 0 to 4 years (median, 3 years). Mean age at entry was 60 years, and systolic/diastolic blood pressure was 154/92 mm Hg. The rate of cardiovascular events (x100 patient-years) was 1.3 in the group with normal LV mass and 3.2 in the group (28.5% of total sample) with LV mass > or =125 g/body surface area (p = 0.005). After adjustment for age (p < 0.01), diabetes (p < 0.01), cigarette smoking (p < 0.01) and serum creatinine (p = 0.03), LV hypertrophy was associated with an increased risk of events (RR [relative risk] 2.08; 95% CI [confidence interval]: 1.22 to 3.57). For each 39 g/m(2) (1 SD) increase in LV mass there was an independent 40% rise in the risk of major cardiovascular events (95% CI: 14 to 72; p = 0.0013).
Conclusions:
Our findings show a strong, continuous and independent relationship of LV mass to subsequent cardiovascular morbidity. This is the first study to extend such demonstration to a large nationwide multicenter sample of uncomplicated subjects with essential hypertension.