Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study

Abstract

A pattern of left ventricular hypertrophy evident on the electrocardiogram is a harbinger of morbidity and mortality from cardiovascular disease. Echocardiography permits the noninvasive determination of left ventricular mass and the examination of its role as a precursor of morbidity and mortality. We examined the relation of left ventricular mass to the incidence of cardiovascular disease, mortality from cardiovascular disease, and mortality from all causes in 3220 subjects enrolled in the Framingham Heart Study who were 40 years of age or older and free of clinically apparent cardiovascular disease, in whom left ventricular mass was determined echocardiographically. During a four-year follow-up period, there were 208 incident cardiovascular events, 37 deaths from cardiovascular disease, and 124 deaths from all causes. Left ventricular mass, determined echocardiographically, was associated with all outcome events. This relation persisted after we adjusted for age, diastolic blood pressure, pulse pressure, treatment for hypertension, cigarette smoking, diabetes, obesity, the ratio of total cholesterol to high-density lipoprotein cholesterol, and electrocardiographic evidence of left ventricular hypertrophy. In men, the risk factor-adjusted relative risk of cardiovascular disease was 1.49 for each increment of 50 g per meter in left ventricular mass corrected for the subject's height (95 percent confidence interval, 1.20 to 1.85); in women, it was 1.57 (95 percent confidence interval, 1.20 to 2.04). Left ventricular mass (corrected for height) was also associated with the incidence of death from cardiovascular disease (relative risk, 1.73 [95 percent confidence interval, 1.19 to 2.52] in men and 2.12 [95 percent confidence interval, 1.28 to 3.49] in women). Left ventricular mass (corrected for height) was associated with death from all causes (relative risk, 1.49 [95 percent confidence interval, 1.14 to 1.94] in men and 2.01 [95 percent confidence interval, 1.44 to 2.81] in women). We conclude that the estimation of left ventricular mass by echocardiography offers prognostic information beyond that provided by the evaluation of traditional cardiovascular risk factors. An increase in left ventricular mass predicts a higher incidence of clinical events, including death, attributable to cardiovascular disease.

Cardiac Time Intervals Measured by Tissue Doppler Imaging M‐mode: Association With Hypertension, Left Ventricular Geometry, and Future Ischemic Cardiovascular Diseases

“…In addition, the IVRT/ET and the MPI displayed cardiac dysfunction after multivariable adjustment in all pathological LV geometry groups (Figure 6). These findings of incremental impairment of the cardiac time intervals (especially the IVRT/ET and MPI) with increasing BP and LVMI (Figure 5), and in all types of pathological LV geometry, are important, because a potential future echocardiographic parameter for risk stratification in hypertension should display incremental impairment in the measure with increasing BP and LVMI and in all types of pathological LV geometry, as the risk of ICVD increases continuously with increasing BP5 and LVH 7, 8…”

“…Asymptomatic organ damage is an intermediate in the continuum from elevated BP to fulminant ICVD. When asymptomatic organ damage of the heart has occurred, the progression to fulminant ICVD is imminent, explaining the increased risk of ICVD with the observation of asymptomatic organ damage 1, 6, 7, 8. Increased BP and hypertension leads to specific changes in the heart characterized by left ventricular (LV) hypertrophy (LVH) and diastolic dysfunction 1, 9, 10.…”

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community

“…The increased central blood pressures associated with decreased aortic compliance are associated with greater left ventricular mass and concentric remodeling. Greater aortic stiffness, increased left ventricular mass, and concentric left ventricular geometry are all associated with increased risk of future adverse cardiovascular and cerebrovascular events 8, 9, 10, 11, 12, 13. Thus, indexes of altered aortic geometry may be useful for cardiovascular disease (CVD) risk stratification.…”

Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

“…The prognostic value of echocardiographic left ventricular (LV) mass1, 2 and its regression with treatment3, 4, 5, 6 are well established. During the past 2 decades, several studies have suggested that the geometric pattern of the left ventricle may improve cardiovascular risk stratification in patients with hypertension 2, 7, 8, 9, 10.…”