Data are limited about the significance of left ventricular (LV) hypertrophy or mass
in patients with coronary heart disease (CHD), particularly in the setting of normal
ejection fraction (EF). The association of LV mass index with all-cause mortality
and sudden death in a cohort with CHD was evaluated. Using transthoracic echocardiography,
LV mass normalized to body surface area was measured in 1,016 subjects with stable
CHD. Cox proportional hazards models were used to examine the association of LV mass
index and LV hypertrophy (LV mass index >95 g/m2 in women and >115 in men) with time to death and time to sudden or arrhythmic death.
Mean LV mass index was 101 ± 27 g/m2 in men and 88 ± 23 in women. During a mean follow-up of 3.55 years, there were 146
deaths and 34 sudden or arrhythmic deaths. Total mortality was higher in subjects
with LV hypertrophy (25% vs 11%, p <0.001), as was mortality from sudden or arrhythmic
death (6.7% vs 2.2%, p = 0.001). After adjustment for age, gender, cardiovascular
risk factors, and medical therapy, LV hypertrophy was associated with both all-cause
mortality (hazard ratio 2.0, p <0.001) and sudden or arrhythmic death (hazard ratio
3.1, p = 0.003). Findings were similar in the subgroup with EF ≥55% (mortality hazard
ratio 1.8, p = 0.02; sudden and arrhythmic death hazard ratio 3.1, p = 0.02). Analyzed
as a continuous variable, every 20-unit increase in LV mass index increased the adjusted
hazard of death by 22% (p = 0.001) and adjusted hazard of sudden or arrhythmic death
by 40% (p = 0.004). In conclusion, in patients with stable CHD, increased LV mass
index was independently associated with all-cause mortality and sudden or arrhythmic
death, even in subjects with normal EF.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- M-Mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study).Am J Cardiol. 2001; 87: 1051-1057
- Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study.J Am Coll Cardiol. 2001; 38: 1829-1835
- Increased left ventricular mass and hypertrophy are associated with increased risk for sudden death.J Am Coll Cardiol. 1998; 32: 1454-1459
- Standardization of M-mode echocardiographic left ventricular anatomic measurements.J Am Coll Cardiol. 1984; 4: 1222-1230
- Left ventricular geometry and mortality in patients >70 years of age with normal ejection fraction.Am J Cardiol. 2006; 98: 1396-1399
- Depressive symptoms and health-related quality of life: the Heart and Soul Study.JAMA. 2003; 290: 215-221
- Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.J Am Soc Echocardiogr. 1989; 2: 358-367
- Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr. 2005; 18: 1440-1463
- The prevalence and correlates of echocardiographic left ventricular hypertrophy among employed patients with uncomplicated hypertension.J Am Coll Cardiol. 1986; 7: 639-650
- The cardiovascular risk factor, left ventricular hypertrophy, is highly prevalent in stable, treated angina pectoris.Am J Hypertens. 2007; 20: 1029-1035
- Proportional hazards tests and diagnostics based on weighted residuals.Biometrika. 1994; 81: 515-526
- Partial residuals for the proportional hazards regression model.Biometrika. 1982; 69: 239-241
- Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study.J Am Coll Cardiol. 2006; 47: 1161-1166
- Factors influencing appropriate firing of the implanted defibrillator for ventricular tachycardia/fibrillation: findings from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II).J Am Coll Cardiol. 2005; 46: 1712-1720
- Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy.J Am Coll Cardiol. 2002; 40: 2156-2164
- Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance.J Am Coll Cardiol. 2003; 41: 1561-1567
- Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy.N Engl J Med. 2000; 342: 1778-1785
- Myocardial scars more frequent than expected: magnetic resonance imaging detects potential risk group.J Am Coll Cardiol. 2006; 48: 765-771
- Microvolt T wave alternans in human cardiac hypertrophy: electrical instability and abnormal myocardial arrangement.J Cardiovasc Electrophysiol. 2001; 12: 759-763
Article info
Publication history
Published online: August 29, 2008
Accepted:
June 30,
2008
Received in revised form:
June 30,
2008
Received:
May 5,
2008
Footnotes
Dr. Turakhia was supported by grants from the American College of Cardiology and Merck Foundation. The Heart and Soul Study was supported by the Department of Veterans Affairs, the National Heart, Lung and Blood Institute (R01 HL079235), the American Federation for Aging Research, the Robert Wood Johnson Foundation, and the Ischemia Research and Education Foundation.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
