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Published on: February 16, 2016
Prognostic value of left ventricular mass normalized to different body size indexes: findings from the PAMELA
Cesare Cuspidi1, Rita Facchetti, Michele Bombelli
1aDepartment of Health Science, University of Milano-Bicocca bIstituto Auxologico Italiano IRCCS cDepartment of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milan, Italy dUniversity Clinical Hospital Centre 'Dragisa Misovic', Belgrade, Serbia eIRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
Insights
Left ventricular hypertrophy (LVH) increases cardiovascular and all-cause mortality risk in the general population, regardless of how left ventricular mass (LVM) is indexed. Height-based indexing for LVH showed no increased mortality in a small subgroup.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Left ventricular hypertrophy (LVH) is a significant predictor of cardiovascular events.
- Accurate assessment of LVH using left ventricular mass (LVM) indexation is crucial for risk stratification.
- Previous studies have shown varied results depending on the indexation method used.
Purpose of the Study:
- To estimate the risk of cardiovascular and all-cause mortality associated with LVH.
- To evaluate the impact of different LVM indexation methods (e.g., by body surface area or height) on mortality risk.
- To assess LVH prevalence and its prognostic implications in a general population sample.
Main Methods:
- The study analyzed data from 1716 individuals in the general population of Monza.
- LVH was defined using four sex-specific criteria based on LVM indexation.
- Mortality data were collected over an average follow-up of 211 months, with adjustments for baseline covariates.
Main Results:
- LVH prevalence varied from 14.2% (LVM/BSA) to 18.0% (LVM/height).
- An increased risk of cardiovascular mortality was observed in patients with LVH, irrespective of the indexation method.
- Similar increased risks were found for all-cause mortality and when LVM was analyzed as a continuous variable.
Conclusions:
- LVH is consistently associated with increased cardiovascular and all-cause mortality in the general population.
- Height-based LVH detection did not show increased mortality in a small subgroup, warranting further investigation.
- The findings underscore the prognostic importance of LVH, regardless of the specific indexation method employed.
Aim:
We estimated the risk of cardiovascular and all-cause mortality associated with left ventricular hypertrophy (LVH) as assessed by left ventricular mass (LVM), normalized by various indexation methods in 1716 representatives of the general population of Monza, enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study.
Methods:
LVH was defined according to four sex-specific criteria derived from the upper limits of normality for LVM index in the healthy normotensive fraction of the Pressioni Arteriose Monitorate E Loro Associazioni population. Death certificates were collected over an average 211 months of follow-up.
Results:
During follow-up, 89 fatal cardiovascular events and 264 all-cause deaths were observed. LVH prevalence rates in the whole population ranged from 14.2% [LVM/body surface area (BSA)] to 18.0% (LVM/height). Adjusted risk (for baseline covariates, including ambulatory blood pressure) of cardiovascular mortality was increased in patients with LVH, regardless of the indexation type: LVH/BSA [hazard ratio 3.19, 95% confidence interval (CI) 2.02-5.06, P < 0.0001], LVH/height (hazard ratio 2.39, 95% CI 1.51-3.78, P = 0.0002), LVH/height (hazard ratio 2.38, 95% CI 1.50-3.76, P = 0.0002), LVH/height (hazard ratio 2.28, 95% CI 1.44-3.60 P = 0.0004). Similar findings were observed for all-cause mortality and when LVM was assessed as a continuous variable. The fraction of patients (5%) classified into the LVH group by height, but not by BSA, had a mild increased LVM index and showed no increased risk.
Conclusions:
LVH, irrespective of indexation methods for LVM, confers an increased risk of cardiovascular and all-cause mortality in the general population. LVH, detected by height-based indexes, but not by BSA-based criteria, was not associated with increased mortality; this finding, however, was based on a small group of patients and will deserve further investigations.
