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Differential value of left ventricular mass index and wall thickness in predicting cardiovascular prognosis: data
Cesare Cuspidi1, Rita Facchetti2, Michele Bombelli2
1Department of Health Science, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano IRCCS, Milan, Italy; cesare.cuspidi@unimib.it.
Insights
Left ventricular mass index, not wall thickness, predicts cardiovascular events in the general population. Echocardiographic laboratories should systematically estimate LV mass index for accurate cardiovascular risk assessment.
Area of Science:
- Cardiology
- Echocardiography
- Public Health
Background:
- Echocardiographic assessment of left ventricular hypertrophy (LVH) has varying definitions.
- The prognostic value of LVH defined by wall thickness versus mass is not well-established.
Purpose of the Study:
- To investigate the predictive value of LV mass index, wall thickness, and relative wall thickness (RWT) for cardiovascular events.
- To clarify the prognostic implications of different echocardiographic measures of LVH in the general population.
Main Methods:
- 1,716 subjects underwent echocardiography, ambulatory blood pressure monitoring, and laboratory tests.
- Subjects were categorized into quintiles based on LV mass, LV mass indexed to body surface area (BSA) or height(2.7), and various wall thickness measurements (IVS, PW, IVS+PW, RWT).
Main Results:
- Over 148 months, 139 cardiovascular events occurred.
- Higher LV mass indexed to BSA or height(2.7) significantly predicted cardiovascular events (RR=2.72-4.83).
- LV wall thickness (IVS, PW, IVS+PW, RWT) did not reliably predict cardiovascular events.
Conclusions:
- LV mass index, but not LV wall thickness, is a reliable predictor of cardiovascular risk in LVH.
- Echocardiographic laboratories should routinely report LV mass index for cardiovascular risk stratification.
Background:
Data on the prognostic value of echocardiographic left ventricular (LV) hypertrophy (LVH) as defined by LV wall thickness rather than LV mass estimate are scarce and not univocal. Thus, we investigated the value of LV mass index, wall thickness, and relative wall thickness (RWT) in predicting cardiovascular events in the PAMELA population.
Methods:
At entry 1,716 subjects underwent diagnostic tests, including laboratory investigations, 24-hour ambulatory blood pressure (BP) monitoring, and echocardiography. For the purpose of this analysis, all subjects were divided into quintiles of LV mass, LV mass/ body surface area (BSA), LV mass/height(2.7), interventricular septum (IVS), posterior wall (PW) thickness, IVS+PW thickness, and RWT.
Results:
Over a follow-up of 148 months, 139 nonfatal or fatal cardiovascular events were documented. After adjustment for age, sex, BP, fasting blood glucose, total cholesterol, and use of antihypertensive drugs, only the subjects stratified in the highest quintiles of LV mass indexed to body surface area (BSA) or height(2.7) exhibited a greater likelihood of incident cardiovascular disease (relative risk (RR) = 2.72, 95% confidence interval (CI) = 1.05-7.00, P = 0.03; RR = 4.83, 95% CI = 1.45-16.13, P = 0.01, respectively) as compared with the first quintile (reference group). The same was not true for the highest quintiles of IVS, PW thickness, IVS+PW thickness, and RWT. Similar findings were found when echocardiographic parameters were expressed as continuous variables.
Conclusions:
This study indicates that LV wall thickness, different from LV mass index, does not provide a reliable estimate of cardiovascular risk associated with LVH in a general population. From these data it is recommended that echocardiographic laboratories should provide a systematic estimate of LV mass index, which is a strong, independent predictor of incident cardiovascular disease.
