The prognostic legacy of left ventricular hypertrophy: cumulative evidence after the MAVI study

Although regression of left ventricular hypertrophy (LVH) confers a marked prognostic benefit, it is unknown whether cardiovascular risk in these patients is comparable to those who never developed LVH.

We analyzed the 'Massa Ventricolare sinistra nell'Ipertensione' (MAVI) study, a prospective study in which serial changes in left ventricular mass at echocardiography were associated with subsequent cardiovascular events. We also conducted a cumulative meta-analysis in order to investigate how evidence progressed in this field. We defined three phenotypes: persistently normal left ventricular mass; LVH regression; persistence/new development of LVH.

Left ventricular mass was measured at baseline and 2 years after the initial assessment in 374 patients (64% women). Clinical outcomes were ascertained after the 2-year echocardiographic evaluation (mean follow-up 3.2 years). Persistence or new development of LVH was associated with an increased risk of cardiovascular events (odds ratio 1.96, 95% confidence interval 1.07-3.57, P = 0.029). In a cumulative meta-analyses that included MAVI and six comparable studies for a total of 2954 patients and 339 cardiovascular events, when a persistently normal left ventricular mass was taken as reference, regression of LVH was associated with 56% higher risk of cardiovascular events (odds ratio 1.56, 95% confidence interval 1.04-2.36, absolute risk increase 3%, P = 0.033). Conversely, evidence accrued from previous studies that persistence or new development of LVH predicts an adverse outcome did not change after MAVI.

Cardiovascular risk is higher in patients with LVH regression than in those with persistently normal left ventricular mass. Preventing development of LVH is thus an important target.