Prognostic Impact of Left Ventricular Mass Severity According to the Classification Proposed by the American Society of Echocardiography/European Association of Echocardiography

Andrea Barbieri,Francesca Bursi,Francesca Mantovani,Chiara Valenti,Michele Quaglia,Elena Berti,Massimiliano Marino,Maria Grazia Modena

doi:10.1016/j.echo.2011.08.012

Andrea Barbieri, Francesca Bursi + Show 6 more

Open Access

https://doi.org/10.1016/j.echo.2011.08.012

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Abstract

The American Society of Echocardiography (ASE) and European Association of Echocardiography (EAE) recommend the use of quantitative estimation of left ventricular (LV) mass and defined partition values for mild, moderate, and severe hypertrophy. However, the prognostic implications associated with this categorization are unknown. In this observational cohort study of unselected adults undergoing echocardiography for any indication, LV hypertrophy was assessed using the ASE/EAE-recommended formula and measurement convention from LV linear dimensions indexed to body surface area. Mortality and incident hospitalizations for cardiovascular disease were the outcomes of this study. Of 2,545 subjects (mean age, 61.9 ± 15.8 years; 56.3% women), 52.9% had normal LV mass, and 15.4% had mild, 12.1% moderate, and 19.6% severe LV hypertrophy. During a mean follow-up period of 2.5 ± 1.2 years, 121 deaths and 292 incident hospitalizations for cardiovascular disease occurred. In multivariate models including age, gender, LV ejection fraction, wall motion score index, significant valvular disease, and atrial fibrillation, the adjusted hazard ratios for death were 1.81 (95% confidence interval [CI], 1.03-3.20; P= .041) for mild, 2.31 (95% CI, 1.33-4.01; P= .003) for moderate, and 2.30 (95% CI, 1.39-3.79, P= .001) for severe LV hypertrophy. The adjusted hazard ratios for incident cardiovascular hospitalizations were 1.24 (95% CI, 0.84-1.82; P= .277) for mild, 2.02 (95% CI, 1.42-2.88; P= .0001) for moderate, and 2.38 (95% CI, 1.75-3.22, P < .0001) for severe LV hypertrophy. After adjustment for known risk predictors, there was a 1.3-fold risk for death and cardiovascular disease events per category of LV mass (P= .001). In a cohort study of unselected adult outpatients, the categorization of LV mass according to the ASE/EAE recommendations offered prognostic information independently of age, gender, and other known predictors.

Highlights

The American Society of Echocardiography (ASE) and European Association of Echocardiography (EAE) recommend the use of quantitative estimation of left ventricular (LV) mass and defined partition values for mild, moderate, and severe hypertrophy
In multivariate models including age, gender, LV ejection fraction, wall motion score index, significant valvular disease, and atrial fibrillation, the adjusted hazard ratios for death were 1.81 (95% confidence interval [confidence intervals (CIs)], 1.03–3.20; P = .041) for mild, 2.31 for moderate, and 2.30 for severe LV hypertrophy
Aim of this study was to examine the prognostic implications of the ASE/ EAE partition values of LV mass in a large group of unselected outpatients referred to a tertiary care echocardiography laboratory

Summary

Methods

In this observational cohort study of unselected adults undergoing echocardiography for any indication, LV hypertrophy was assessed using the ASE/EAE-recommended formula and measurement convention from LV linear dimensions indexed to body surface area. The study population comprised unselected elective adult outpatients who underwent standard Doppler echocardiography for any indication in the period from January 2005 to March 2009 at the echocardiography laboratory of Modena University Hospital. For patients undergoing more than one echocardiographic exam during the aforementioned time frame, we considered only the first access to the echocardiography laboratory. All exams were performed using an Acuson Sequoia ultrasound system (Siemens Medical Solutions USA, Inc., Mountain View, CA) and were performed and/or supervised by cardiologists fully trained in echocardiography with long-standing experience with the technique and intense hands-on training period with interpretation of >750 studies.[12]. LV ejection fraction was assessed using the biplane Simpson method or the Quinones method using LV end-systolic and end-diastolic diameters[13] or visually estimated, a method that was documented to have accuracy comparable with that of the other methods in assessing LV ejection fraction.[14]

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