Relation of Left Ventricular Mass to Prognosis in Initially Asymptomatic Mild to Moderate Aortic Valve Stenosis

Abstract

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/m2.7, 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/m2.7) 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.

Impact of stroke volume on cardiovascular risk during progression of aortic valve stenosis

“…LV hypertrophy was identified by sex-specific cut-off values >46.7 g/m 2.7 in women and >49.2 g/m 2.7 in men, as previously prognostically validated 17. Energy loss (EL) and energy loss index (ELI) were calculated by previously validated equations 18.…”

Disease activity is associated with reduced left ventricular systolic myocardial function in patients with rheumatoid arthritis

“…LV mass was indexed for height 2.7 and LV hypertrophy was considered present if LV mass index exceeded the prognostically validated cut-off values ≥46.7 g/m 2.7 in women and ≥49.2 g/m 2.7 in men 25 26. Concentric geometry was considered present if LV relative wall thickness exceeded the prognostically validated cut-off ≥0.43 27…”

The Future of Cardiovascular Imaging

“…Una enfermedad común tal como la hipertensión con estenosis aórtica eleva la impedancia en serie y, cuando se acopla con aumento de la rigidez aórtica, acompaña al envejecimiento y la ateroesclerosis y contribuye a la carga del VI y el desarrollo de los síntomas en una forma importante. [31][32][33][34][35] Los avances en las imágenes están ahora permitiendo una comprensión más profunda de la biopatología de la enfermedad más que simplemente una comprensión de las consecuencias hemodinámicas de la enfermedad valvular. Un objetivo de la imagen multimodal es facilitar el diagnóstico temprano así como potencialmente afectar su progreso.…”