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Relation of Left Ventricular Mass to Prognosis in Initially Asymptomatic Mild to Moderate Aortic Valve Stenosis
Eva Gerdts1, Anne B Rossebø2, Terje R Pedersen2
1From the Department of Clinical Science, University of Bergen, Bergen, Norway (E.G., M.T.L.); Department of Cardiology (A.B.R.) and Centre for Preventive Medicine (T.R.P.), Oslo University Hospital Ullevaal, Oslo, Norway; Department of Cardiology, Villa Bianca Hospital, Trento, Italy (G.C.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (D.C., B.P.R.); and Department of Medicine, Weill Cornell Medical College, New York, NY (R.B.D.). eva.gerdts@k2.uib.no.
Insights
Increased left ventricular (LV) mass in patients with mild-to-moderate aortic stenosis predicts higher risks of cardiovascular events and mortality. This finding highlights LV mass as a crucial prognostic marker in aortic stenosis progression.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Echocardiography
Background:
- Prognostic significance of left ventricular (LV) mass in nonsevere asymptomatic aortic stenosis remains under-documented.
- Large-scale prospective studies are needed to clarify the role of LV mass.
Purpose of the Study:
- To investigate the prognostic importance of left ventricular (LV) mass in patients with mild-to-moderate asymptomatic aortic stenosis.
- To assess the association between baseline and in-study LV mass index and cardiovascular events.
Main Methods:
- Prospective cohort study of 1656 patients with mild-to-moderate asymptomatic aortic stenosis from the SEAS trial.
- Cox regression analysis was used to evaluate the impact of baseline and time-varying LV mass index on major cardiovascular events.
- Patients were followed for 4.3 years on simvastatin/ezetimibe or placebo.
Main Results:
- Higher baseline LV mass index independently predicted increased hazards for major cardiovascular events (12%), ischemic events (28%), cardiovascular mortality (34%), and total mortality/heart failure hospitalization (23%).
- In time-varying analyses, higher in-study LV mass index was consistently associated with increased cardiovascular event hazards (13%-61%).
- These associations remained significant independent of confounders including age, sex, BMI, and hypertension.
Conclusions:
- Elevated left ventricular (LV) mass index is an independent predictor of cardiovascular morbidity and mortality in asymptomatic aortic stenosis.
- LV mass progression is linked to adverse cardiovascular outcomes.
- LV mass should be considered in risk stratification for patients with aortic stenosis.
Background:
The prognostic importance of left ventricular (LV) mass in nonsevere asymptomatic aortic stenosis has not been documented in a large prospective study.
Methods And Results:
Cox regression analysis was used to assess the impact of echocardiographic LV mass on rate of major cardiovascular events in 1656 patients (mean age, 67 years; 39.6% women) with mild-to-moderate asymptomatic aortic stenosis participating in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. Patients were followed during 4.3 years of randomized treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily or placebo. At baseline, LV mass index was 45.9+14.9 g/m(2.7), and peak aortic jet velocity was 3.09+0.54 m/s. During follow-up, 558 major cardiovascular events occurred. In Cox regression analyses, 1 SD (15 g/m(2.7)) higher baseline LV mass index predicted increases in hazards of 12% for major cardiovascular events, 28% for ischemic cardiovascular events, 34% for cardiovascular mortality, and 23% for combined total mortality and hospitalization for heart failure (all P<0.01), independent of confounders. In time-varying models, taking the progressive increase in LV mass index during follow-up into account, 1 SD higher in-study LV mass index was consistently associated with 13% to 61% higher hazard for cardiovascular events (all P<0.01), independent of age, sex, body mass index, valvuloarterial impedance, LV ejection fraction and concentricity, and the presence of concomitant hypertension.
Conclusions:
Higher LV mass index is independently associated with increased cardiovascular morbidity and mortality during progression of aortic stenosis.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.
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