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Prognosis of inappropriate left ventricular mass in hypertension: the MAVI Study
Giovanni de Simone1, Paolo Verdecchia, Sergio Pede
1Department of Clinical and Experimental Medicine, School of Medicine, Federico II University Hospital, Naples, Italy. simogi@unina.it
Insights
Excessive left ventricular (LV) mass in hypertensive patients predicts cardiovascular events, independent of traditional risk factors. This finding highlights the prognostic importance of assessing LV mass relative to individual needs for better risk stratification.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiovascular Imaging
Background:
- Left ventricular (LV) mass is a key indicator of cardiac health.
- Assessing LV mass relative to individual needs may offer superior prognostic information compared to traditional measures.
Purpose of the Study:
- To investigate the prognostic impact of excess echocardiographic LV mass in hypertensive individuals.
- To determine if inappropriate LV mass predicts cardiovascular events independently of established risk factors.
Main Methods:
- Prospective study of 1019 white hypertensive patients without prior cardiovascular disease or type 1 diabetes.
- Echocardiographic LV mass was assessed as a percentage of predicted ideal value based on gender, stroke work, and height.
- Cardiovascular events were tracked over a mean follow-up of 35 months.
Main Results:
- 37% of patients had inappropriate (excess) LV mass.
- Age, systolic blood pressure, and percentage of predicted LV mass were significant predictors of cardiovascular events (P<0.01).
- Excess LV mass demonstrated incremental prognostic value over traditional LV mass assessment (P<0.01).
Conclusions:
- Inappropriate LV mass is an independent predictor of cardiovascular events in hypertensive patients.
- This finding holds true regardless of the presence or absence of traditional LV hypertrophy.
- Assessing relative LV mass provides valuable prognostic information beyond standard risk factors.
Abstract:
To evaluate the prognostic impact of left ventricular (LV) mass exceeding individual needs to compensate hemodynamic load, the percentage of excess of echocardiographic LV mass in relation to individual ideal value predicted by gender, stroke work, and height (in meter(2.7)) from a reference population was assessed in 1019 white hypertensives (627 women [24% obese] and 392 men [17% obese, P<0.02 versus women]) without prevalent cardiovascular disease or type 1 diabetes, from the Italian multicenter, prospective study MAVI. Low LV mass (<73% of predicted) was found in 36 patients (3.5%), 661 had appropriate LV mass, and 322 (37%) had inappropriate LV mass. During follow-up (35+/-11 months), 52 fatal or nonfatal primary cardiovascular events occurred. Age, systolic blood pressure, and LV mass as a percentage of the predicted value were significant predictors of cardiovascular events (all P<0.01), independently of gender, glycemia, antihypertensive treatments, and body mass index, even in subgroups with or without LV hypertrophy. Survival analysis showed that cardiovascular risk increased stepwise from the lowest to the highest quintile of LV mass as a percentage of predicted value (P<0.01). The excess LV mass showed incremental prognostic value compared with assessment of traditional LV mass (P<0.01). Thus, inappropriate LV mass predicts a risk of cardiovascular events, independently of risk factors, and remains a significant predictor of risk either in the presence or in the absence of traditionally defined LV hypertrophy.