Increasing Left Ventricular Mass and Death in Men and Women Investigated With Echocardiography

Left ventricular hypertrophy (LVH) categories are based on left ventricular mass index (LVMi). This study aimed to generate and externally validate sex-stratified LVMi cutoffs according to incremental mortality risk.

LVH information was determined on 155 668 men (aged 61.3±17.3 years) and 147 880 women (61.8±18.3 years) from the National Echocardiography Database of Australia. Sex-specific mild to severe thresholds of the increasing 5-year mortality rate based on LVMi increments were generated. These new thresholds were then validated in a US Medicare-linked echocardiographic database.

In the National Echocardiography Database, 36198 men (23.3%) and 38 898 women (26.3%) had LVH, with an actual 5-year mortality rate of 38.3% and 31.2%, respectively. The statistical threshold at which LVMi was associated with an increased mortality rate was lower than traditional criteria in both men (≥88 g/m² versus ≥115 g/m²) and women (≥82 g/m² versus ≥95 g/m²). In men, compared with the lowest-risk LVMi stratum, the fully adjusted risk of 5-year death was 14% (95% CI, 3%-25%) and 68% higher (95% CI, 49%-90%) when LVMi levels were mildly (88 to <116 g/m²) to severely (≥140 g/m²) increased, respectively. In women, the equivalent LVMi thresholds of 82 to <112 g/m² and ≥140 g/m² were associated with a 13% (95% CI, 3%-24%), and 81% higher (95% CI, 58%-208%) risk. The association of these LVMi thresholds and mortality risk was confirmed in the US validation cohort selected for the absence of 27 separate comorbidities (n=12 355; mean age, 65.9±13.1 years; 49.7% female).

A high proportion of men and women have LVMi levels associated with an elevated mortality risk, despite absence of LVH. Such individuals may benefit from more proactive recognition and clinical management.