Value Of Left Ventricular Hypertrophy Research Articles

Prognostic value of left ventricular hypertrophy in patients with myocardial fibrosis by ECV mapping on cardiac MRI

Abstract Background Cardiovascular magnetic resonance (CMR) can noninvasively identify myocardial fibrosis using extracellular volume (ECV) mapping. In patients with elevated ECV, and without hypertrophic cardiomyopathy (HCM) or cardiac amyloidosis, the prognostic significant of mild-to-moderate left ventricular hypertrophy (LVH) has not been well established. Purpose To determine if the presence of mild to moderate LVH has an impact on major adverse cardiovascular outcomes (MACE) in patients with elevated ECV without HCM or cardiac amyloidosis. Methods This was a retrospective cohort study assessing a group of patients referred for CMR between July 2019 and January 2023 to Mount Sinai Morningside. Patients with ECV>30% and left ventricular wall thickness <1.6 cm (to exclude patients with the possible diagnosis of HCM or cardiac amyloidosis) were considered for inclusion. Those with an established diagnosis of HCM or cardiac amyloidosis were also excluded. The LVH group comprised of patients with mild-to-moderate LVH, defined as a maximum wall thickness of 1.2-1.5 cm. The control group included patients without LVH (wall thickness <1.2 cm). Patients were further stratified by ECV, using the median value for our sample, as "high ECV" (≥35%) or "low ECV" (<35%). The outcome of interest was time-to-first MACE (all-cause death, or incident acute coronary syndrome, acute heart failure, or arrhythmia). Time-to-first MACE within 1 year was compared among groups using unadjusted Kaplan-Meier curves. Additional Cox regression analyses were performed to adjust for significant univariate analysis, including hypertension, hyperlipidemia, diabetes mellitus, use of beta-blocker, use of diuretic, and category of glomerular filtration rate. The results are presented as hazard ratios and 95% confidence intervals. All analyses were performed in SAS Enterprise using α<0.05. Results Out of the cohort, we identified 186 patients that met our selection criteria. The mean age was 61.1 ± 15.5 years, and 58.1% of patients were female. The median follow-up was 175 days in the control group and 115 days in the LVH group. There were 61 MACE (32.8%) in our sample. After adjusting for covariates, mild-to-moderate LVH was associated with 2.2 times the risk of MACE (95%CI 1.3 to 3.8; p=0.0047) at 1 year, compared to patients without LVH. A higher ECV (≥35%) was not significantly associated with worse outcomes within each study arm (p=0.3450). Kaplan Meier survival curves for patients with and without LVH are shown in Figure 1 (p=0.0002). Conclusions In patients with evidence of elevated ECV without underlying cardiac amyloidosis or hypertrophic cardiomyopathy, mild-to-moderate LVH is associated with 2.2 times the risk of MACE compared to normal left ventricular wall thickness.Figure 1

The role of left ventricular hypertrophy measured by echocardiography in screening patients with ischaemia with non-obstructive coronary arteries: a cross-sectional study.

Many patients with ischaemia with non-obstructive coronary arteries (INOCA) have a poor prognosis. This study aims to explore the diagnostic value of left ventricular hypertrophy (LVH)-related ultrasound parameters in INOCA patients. The study group consisted of 258 patients with INOCA in this retrospective cross-sectional study, and these patients were free of obstructive coronary artery disease, previous revascularization, atrial fibrillation, ejection fraction < 50%, major distortions of left ventricular geometry, suspected non-ischaemic causes. Control individuals were matched 1:1 with study group according to age, sex, cardiovascular risk factors, and time of hospital stay. According to left ventricular mass index (LVMI) and relative wall thickness, left ventricular geometry was composed of concentric hypertrophy, eccentric hypertrophy, concentric remodeling and normal geometry. LVH-related parameters, left ventricular geometry, demographic characteristics, laboratory parameters and other echocardiographic indicators were compared between the two groups. Subgroup analysis was performed based on sex. LVMI in the study group was higher than that in the control group (86.86 ± 18.83g/m2 vs 82.25 ± 14.29g/m2, P = 0.008). The ratio of LVH was higher in the study group (20.16% vs 10.85%, P = 0.006). After subgroup analysis based on sex, LVMI differences (85.77 ± 18.30g/m2 vs 81.59 ± 14.64g/m2, P = 0.014) and the ratio of LVH differences (25.00% vs 14.77%, P = 0.027) still existed in females between the two groups. There was no difference in the constituent ratio of left ventricular geometry between the two groups (P = 0.157). Sex-based subgroup analysis showed no difference in the constituent ratio of left ventricular geometry between the two groups in females (P = 0.242). The degree of LVH in the study group was higher than that in the control group, suggesting that LVH may play an important role in the occurrence and development of INOCA. Moreover, LVH-related ultrasound parameters may be of higher diagnostic value for female INOCA patients than for male INOCA patients.

Left ventricular hypertrophy, diastolic dysfunction and right ventricular load predict outcome in moderate aortic stenosis.

Predictors of progression of moderate aortic valve stenosis (AS) are incompletely understood. The objective of this study was to evaluate the prognostic value of left ventricular hypertrophy (LVH), diastolic dysfunction, and right ventricular (RV) load in moderate AS. Moderate AS was defined by aortic valve area (AVA), peak transvalvular velocity (Vmax) or mean pressure gradient (PGmean). A total of 131 Patients were divided into two groups according to the number of pathophysiological changes (LVH, diastolic dysfunction with increased LV filling pressures and/or RV load): <2 (group 1); ≥2 (group 2). The primary outcome was survival without aortic valve replacement (AVR). After follow-up of 30 months, the reduction of AVA (-0.06 ± 0.16 vs. -0.24 ± 0.19 cm2, P < 0.001), the increase of PGmean (2.89 ± 6.35 vs 6.29 ± 7.13 mmHg, P < 0.001) and the decrease of the global longitudinal strain (0.8 ± 2.56 vs. 1.57 ± 3.42%, P < 0.001) from baseline to follow-up were significantly more pronounced in group 2. Survival without AVR was 82% (group 1) and 56% (group 2) [HR 3.94 (1.74-8.94), P < 0.001]. Survival without AVR or progression of AS was 77% (group 1) and 46% (group 2) [HR 3.80 (1.84-7.86), P < 0.001]. The presence of ≥2 pathophysiological changes predicted outcome whereas age, comorbidities, LDL-cholesterol did not. The presence of ≥2 pathophysiological changes is a strong predictor of outcome in moderate AS and may be useful for risk stratification, particularly for scheduling follow-up time intervals and deciding the timing of AVR.

Valor pronóstico de la hipertrofia ventricular izquierda valorada por voltaje en electrocardiograma en pacientes con síndrome coronario crónico

Introduction and objectivesMost patients with chronic coronary syndrome altered electrocardiogram hypertension, but the prognostic value of left ventricular hypertrophy (LVH) assessed by electrocardiogram criteria is unknown. MethodsRetrosprospective registry of all patients with chronic coronary syndrome attended in a monographic clinic. We calculated the Cornell index and Sokolov-Lyon index and values> 28 (men) or> 20 (women) were considered for LVH for the first and> 35mm in the second. During follow-up, all-cause or cardiovascular mortality or major cardiovascular events (MACE), considering reinfarction, heart failure, cerebrovascular accident, or major hemorrhage, were evaluated. ResultsA total of 774 patients were included and 60 (8.31%) fulfilled the LVH criteria by the electrocardiogram. The median follow-up was 960 days [interquartile range 538-1586] and during this period 33 (4.6%) patients died, 22 (3.1%) of the deaths were attributable to cardiovascular causes, and 110 (15,2%) patients presented a MACE. In the multivariate analysis, adjusted for age, sex, diabetes, medical treatment and heart rate, both Cornell and Sokolow-Lyon index were linearly associated with a higher risk of death from any cause (HR, 1.11; 95%CI, 1.07-1.16; P> .001), due to cardiovascular causes (HR, 1.11; 95%CI, 1.06-1.17; P> .001) and MACE (HR, 1.04; 95%CI, 1.01-1.06; P=.015). An independent risk was also observed for LVH. ConclusionsLVH, obtained by electrocardiogram criteria, has a high predictive value for mortality and major cardiovascular complications in patients with chronic coronary syndrome.

Expression of soluble ST2 in patients with essential hypertension and its relationship with left ventricular hypertrophy.

Identification and intervention of left ventricular hypertrophy (LVH) in essential hypertension (EH) are important for the prevention of adverse cardiovascular events. However, effective methods for diagnosing LVH are still lacking. This study aimed to explore the relationship between soluble ST2 (sST2) and LVH in EH patients to identify a potential specific biomarker for hypertensive LVH. This study included 97 EH patients. Based on the criteria for LVH, participants were divided into the LVH group (n=52) and the non-LVH group (n=45). The level of serum sST2 was detected by enzyme-linked immunosorbent assay. Pearson correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used to investigate the potential of sST2 as a biomarker of LVH in EH patients. Compared with the non-LVH group, the sST2 level was elevated in EH patients with LVH (P<0.001). Pearson correlation analysis indicated that the sST2 level was positively correlated with the left ventricular mass index in EH patients (r=0.454, P<0.001). Logistic regression analysis showed that the odds ratio (OR) value of LVH was 2.990, suggesting that sST2 is an independent risk factor for LVH in EH patients [OR=2.990, 95% confidence interval (CI), 1.650-5.419; P<0.001]. The area under the ROC curve was 0.767 (95% CI, 0.669-0.866; P<0.001), with a sensitivity of 0.808 and specificity of 0.689, indicating the possibility of considering sST2 as a biomarker for diagnosing LVH. Up-regulation of sST2 is strongly related to LVH in EH patients, is an independent risk factor for hypertensive LVH, and can be used as a biomarker for the diagnosis of LVH.

Prognostic value of left ventricular hypertrophy in postoperative outcomes in type A acute aortic dissection.

BackgroundLeft ventricular hypertrophy (LVH) is common in hypertension patients. Hypertension is a recognized risk factor of acute aortic dissection. This study aimed to explore the prognostic value of LVH in predicting postoperative outcomes in acute type A aortic dissection (ATAAD) patients.MethodsThis was a single-central retrospectively designed study. One hundred and ninety-three ATAAD patients who underwent surgical repair at Renmin Hospital of Wuhan University from January 2018 to November 2021 were enrolled. Patients were divided based on their left ventricular mass index (LVMI). We compared their baseline characteristics, perioperative data, and in-hospital outcome. Then nomogram models were developed based on logistic regression to predict the postoperative outcomes.ResultsLVH presented in 28.5% (55 in 193) patients. LVH group had a higher proportion of female patients compared with the non-LVH group (32.7% vs. 17.4%, P=0.03). Decreased left ventricular ejection fraction and cardiac tamponade were more prevalent in patients with LVH. LVH group had a higher risk of postoperative composite major outcomes (CMO) and operative mortality. Based on multivariable logistic regression, LVH/LVMI, Penn classification, hyperlipidemia, emergency surgery and cardiopulmonary bypass duration were applied to develop nomogram models for predicting postoperative CMO. The area under curve was 0.825 (95% CI: 0.749–0.900) for Model LVH and 0.841 (95% CI: 0.776–0.905) for Model LVMI. Nomogram models for predicting postoperative cardiac were developed based on LVH/LVMI and cardiopulmonary bypass duration. The area under curves for the models involving LVH or LVMI were 0.782 (95% CI: 0.640–0.923) and 0.795 (95% CI: 0.643–0.947), respectively.ConclusionsLVH and increased LVMI was associated with increased risk of postoperative CMO and cardiac events in ATAAD patients. The nomogram models based on LVH or LVMI might help predict postoperative CMO. Future research would be necessary to investigate prognostic value of LVH for long-term outcomes in ATAAD patients.

Prognostic value of secondary cardiac alterations in patients with moderate aortic valve stenosis

Abstract Purpose Echocardiographic characteristics that predict the progression of moderate aortic valve stenosis (mAS) are lacking. The aim of the present study was to evaluate the prognostic value of left ventricular hypertrophy (LVH), diastolic dysfunction (DD) and pulmonary artery hypertension (PAH) in patients with mAS. Methods A total of 137 patients with asymptomatic mAS (age 72±10 years; females: 51 (37%); Blood Pressure: 143±21 / 78±13 mmHg) were included. Echocardiography was performed at baseline and at follow-up every six or/and twelve months. Patients with concomitant valvular defects, hypertrophic cardiomyopathy or chronic obstructive pulmonary disease were excluded. mAS was defined by current guideline criteria. Left ventricular ejection fraction (LVEF), LVH (LV mass index, males: &amp;gt;115g/m2, females: &amp;gt;95 g/m2), DD (E/e' &amp;gt;14) and PAH (maximum regurgitant velocity of tricuspid valve (TRVmax) &amp;gt;2.8m/s) were assessed. mAS patients were divided into 4 subgroups based on the number of secondary cardiac alterations: (0) no; (1) one; (2) two; (3) three cardiac alterations. The primary endpoint was progression to severe AS with indication for treatment (effective aortic orifice area (EOA) by continuity equation &amp;lt;1 cm2/&amp;lt;0.6 cm2/m2) or the onset of symptoms. Results mAS patients showed (0) no secondary cardiac alterations in 20% (n=28), (1) one in 40% (n=55), (2) two in 26% (n=35) and (3) three in 14% (n=19). Among mAS subgroups, no significant differences were observed for age and comorbidities. Echocardiographic parameters are summarised in Tab.1. In general, mAS patients with ≥ two cardiac alterations showed significantly smaller EOA ((0): 1.32±0.19 vs. 1.29±0.19, p&amp;gt;0.05; (1): 1.26±0.21 vs. 1.18±0.21, p&amp;gt;0.05; (2): 1.29±0.20 vs. 1.01±0.20, p&amp;lt;0.01; (3): 1.31±0.16 vs. 1.06±0.25, p&amp;lt;0.01) and higher mean pressure gradients (PGmean) ((0): 19.8±6.64 vs. 21.8±6.32, p&amp;gt;0.05; (1): 20.0±9.26 vs. 22.3±9.94, p&amp;gt;0.05; (2): 22.7±9.32 vs. 30.5±12.61, p&amp;lt;0.01 (3): 25.0±8.87 vs. 29.4±10.67, p&amp;lt;0.01) between baseline and follow-up (mean follow-up 20±9 months). Further, decrease of EOA/days was significantly higher in these patients ((0) −0.003; (1) −0.006; (2) −0.016; (3) −0.028; p&amp;lt;0.01, Fig. 1). As shown in Kaplan-Meier curve, mAS with ≥ two cardiac alterations showed rapid progression of moderate to severe AS (Fig. 2). Conclusions In 40% of patients with mAS ≥ two secondary cardiac alterations (LV hypertrophy, DD and PAH) were observed. The presence of ≥ two of these secondary cardiac alterations is associated with rapid progression of mAS. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Factors associated with diagnostic discrepancy for left ventricular hypertrophy between electrocardiography and echocardiography

Objective: To investigate the influence of cardiovascular risk factors, including fasting plasma glucose (FPG), on the association between electrocardiographic (ECG) and echocardiographic left ventricular hypertrophy (LVH) in an elderly population.Methods: We tested cross-sectional associations between electrocardiographic and echocardiographic LVH, defining LVH according to the Sokolow-Lyon voltage combination, Cornell voltage-duration product, or left ventricular mass index (LVMI). Differences between standardized LVMI and Sokolow-Lyon voltage combination or Cornell voltage-duration product (absolute value/cut-off value for LVH) were used as outcome variables in order to identify explanatory variables associated with diagnostic discrepancies between ECG and echocardiography.Results: Of the 1382 subjects included, 77% did not display any signs of LVH, 6% had LVH defined by ECG only, 13% had LVH defined by echocardiography only, and 5% had LVH on both ECG and echocardiography. Older subjects and those with higher blood pressure and RWT were more likely to have a relatively greater LVMI on echocardiography than that predicted on ECG (odds ratio: 1.65 per 10 years (95% confidence interval (CI): 1.27-2.15), p = .0002, odds ratio: 1.17 per 10 mmHg (95% CI: 1.09-1.25), p < .0001, and odds ratio: 1.21 per 0.10 (95% CI: 1.02-1.42), p = .03). In addition, discrepancy was also seen in females and subjects receiving antihypertensive medication (odds ratio: 1.41 (95% CI: 1.04-1.89), p = .03 and odds ratio: 1.41 (95% CI: 1.06-1.87), p = .02), but FPG did not independently influence discrepancy between ECG and echocardiography.Conclusion: Age, blood pressure, female sex, greater RWT and use of antihypertensive medication were associated with a greater risk of non-consistency between LVH determined by ECG and echocardiography.

Clinical Value of Left Ventricular Hypertrophy in Arterial Hypertension

In this review article we present data on prevalence of left ventricular hypertrophy in patients with arterial hypertension, on predictors of its development, methods of detection, and diagnostic criteria.

Left ventricular hypertrophy as a marker of adverse cardiovascular risk in persons of different age groups

The paper considers modern conceptions about the prognostic value of left ventricular hypertrophy (LVH) different types. The role of interaction of demographic, hemodynamic, regulatory, intracardiac factors in the formation of prognostic peculiarities in patients with different types of LVH is marked. The data of own investigations indicating that the left ventricular myocardial mass has not less important value in long-term general prognostication than belonging to a concentric or eccentric LVH type in elderly patients with hypertension are presented. Some data concerning left atrial dilatation as an inalienable component of the cardiovascular continuum in essential hypertension are submitted. Pathogenic and prognostic contribution of metabolic disorders associated with hypertension and abdominal obesity in the development of the heart's left parts structural and functional disorders is shown. Issues of long-term outcome in elderly hypertensive patients with metabolic syndrome taking into account the peculiarities of left ventricular geometry are highlighted.

Relation of Thoracic Aortic Distensibility to Left Ventricular Area (from the Multi-Ethnic Study of Atherosclerosis [MESA

Decreased arterial compliance is an early manifestation of adverse structural and functional changes within the vessel wall. Its correlation with left ventricular (LV) area on computed tomography, a marker of LV remodeling, has not been well demonstrated. The aim of this study was to test the hypothesis that decreasing aortic compliance and increasing arterial stiffness are independently associated with increased LV area. The study population consisted of 3,540 patients (mean age 61 ± 10 years, 46% men) from the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent aortic distensibility (AD) assessment on magnetic resonance imaging and LV area measurement on computed tomography (adjusted to body surface area). Multivariate logistic regression was performed to assess the association between body surface area-normalized LV area >75th percentile and AD after adjusting for baseline clinical, historical, and imaging covariates. Mean LV area index was 2,153 cm(2), and mean AD was 1.84 × 10(3) mm Hg(-1). Subjects in the lowest AD quartile were older, with higher prevalence rates of hypertension, diabetes, and hypercholesterolemia (p <0.05 for all comparisons). Using multivariate linear regression adjusting for demographics, traditional risk factors, coronary artery calcium, and C-reactive protein, each SD decrease was associated with an 18-cm(2) increase in LV area. In addition, decreasing AD quartiles were independently associated with increasing LV area index, defined as >75th percentile. In conclusion, in this multiethnic cohort, reduced AD was associated with increased LV area. Longitudinal studies are needed to determine if decreased distensibility precedes and directly influences increased LV area.

Cardiovascular risk assessment beyond Systemic Coronary Risk Estimation

Cardiovascular risk assessment in the clinical practice is mostly based on risk charts, such as Framingham risk score and Systemic Coronary Risk Estimation (SCORE). These enable clinicians to estimate the impact of cardiovascular risk factors and assess individual cardiovascular risk profile. Risk charts, however, do not take into account subclinical organ damage, which exerts independent influence on risk and may amplify the estimated risk profile. Inclusion of organ damage markers in the assessment may thus contribute to improve this process. Our aim was to evaluate the influence of implementation of SCORE charts with widely available indexes of organ damage, with the purpose to ameliorate individual risk assessment. We searched www.Pubmed.gov for evidence about the predictive value of left ventricular hypertrophy (LVH), estimated glomerular filtration rate (eGFR), microalbuminuria (MAU) and metabolic syndrome on different risk profiles estimated by SCORE. Interventional and observational trials including at least 200 patients and published after 2000 were selected. The presence of organ damage as well as the number of abnormal parameters indicating organ damage is associated with increased cardiovascular risk, independently of SCORE. In the area of high risk, the impact of different markers of organ damage is heterogeneous. Combined risk models of SCORE and subclinical organ damage have major impact on risk stratification and may impact on recommendation in primary prevention in all SCORE categories. Available evidence suggests a tangible clinical advantage of adding the evaluation of simple organ damage markers to risk charts in cardiovascular risk prediction.

Retinal changes and cardiac remodelling in systemic hypertension

The clinical value of left ventricular hypertrophy (LVH), a cardinal manifestation of hypertensive organ damage, in predicting cardiovascular (CV) events, independently of blood pressure (BP) and other accompanying risk factors, has been widely documented and its role in CV stratification indisputability recognized. Although the examination of the fundus oculi provides a unique opportunity to evaluate retinal microvascular abnormalities, which may mirror systemic arteriolar damage due to high BP, no consistent evidence exists, on the prognostic value of mild degrees of retinopathy, encompassing the vast majority of uncomplicated hypertensive subjects. Personal and literature data indicate that: (1) there is a tight association between advanced retinopathy and LVH suggesting the existence of a parallel involvement of retinal tree and cardiac damage in severe untreated or poorly controlled hypertension; (2) in contrast, a firm conclusion about the relationship between early or nonspecific retinal changes (narrowing or arteriovenous crossing) and cardiac damage is not allowed by the majority of the studies; (3) future investigations, based on computer-assisted methods, are further required to document the relation between initial retinal changes with organ damage and more importantly to test their predictive value for clinical outcomes.

Improved performance of traditional ECG for diagnosis of left ventricular hypertrophy in hypertension

In order to improve performance of traditional electrocardiography (ECG) for diagnosis of left ventricular hypertrophy (LVH), we developed a new index defined by a typical strain pattern or a modified Cornell voltage (R wave amplitude in aVL, plus [(half of the S wave amplitude in V3) x body mass index (BMI) (kg/m )]. ROC curve-based partition value for LVH is 420 mV●kg/m. Halving S wave in V3 and adjustment for BMI result from multivariate analyses of ECG variables for prediction of LV mass. We examined 2612 untreated subjects (age 50 12, 56% men) with essential hypertension and good quality ECG and echo tracings. Prevalence of LVH at echo (LV mass 51.0 g/height—) was 31.1%. The following ECG criteria for LVH were compared with the new index: (a) Romhilt-Estes score 5 points, (b) Sokolow-Lyon voltage; (c) Traditional Cornell voltage (S wave in V3 plus R wave in aVL 2.0 mV (women) and 2.8 mV (men); (d) Perugia score (typical strain pattern or Cornell voltage 2.0 mV (women) and 2.4 mV (men). As shown in the figure, the modified Cornell voltage resulted in a

Comparison of the prognostic value of left ventricular hypertrophy in African-American men versus women

Echocardiographically determined left ventricular (LV) hypertrophy may be a stronger risk factor of cardiovascular disease (CVD) for women than for men, although it is unclear whether reported gender differences are real or attributable to confounding. We evaluated echocardiographic LV hypertrophy (defined as LV mass/height(2.7) >/=51 g/m(2.7)) collected from the African-American population of the Atherosclerosis Risk in Communities Study. Incident CVD events (57 in men, 62 in women) were determined during a median follow-up of 4.9 years (interquartile range 4.3 to 5.6) and included nonfatal myocardial infarction, cardiac death, coronary revascularization, and stroke. We conducted 2 analyses. First, we created matched samples of 340 men and 812 women who had LV hypertrophy based on propensity score and estimated the gender-specific incidence rate ratios and population-attributable risks. Second, we evaluated the complete cohort (604 men and 1,113 women) with Poisson's regression after adjusting for age, body mass index, hypertension, diabetes mellitus, ratio of total cholesterol to high-density lipoprotein cholesterol, current smoking, and education level. LV hypertrophy was significantly predictive of incident CVD, and the association shown by analyses of matched propensity scores was similar in men and women (incidence rate ratio 1.88 vs 1.92, p = 0.97 for men, population-attributable risk 0.22 vs 0.26, p <0.07 for women). In the multivariate analysis, we found comparable effect estimates for LV hypertrophy (incidence rate ratio 1.66 vs 2.09, p = 0.55 for men; population-attributable risk 0.24 vs 0.32, p <0.07 for women). Thus, LV hypertrophy is a strong predictor of CVD in African-Americans, and the effect of LV hypertrophy on CVD is similar in men and women.

Prognostic value of left ventricular hypertrophy and geometry in patients with a first, uncomplicated myocardial infarction

Background: The prognostic impact of left ventricular (LV) geometry on cardiovascular risk for patients with a first, uncomplicated acute myocardial infarction (AMI), and echocardiographic ejection fraction ≥50% has not been well described. Methods and results: Accordingly, 111 AMI consecutive patients (mean age 59.3±10 years) performed echocardiographic examination at predischarge. LV mass was calculated by means of Devereux’s formula and subsequently indexed by body surface area. Fifty-three patients had LV hypertrophy and 58 patients had normal LV mass. The two groups were homogeneous for demographic, clinical and angiographic variables as well as for the incidence of residual ischemia on predischarge stress testing. During follow-up period there were 24 cardiac events (cardiac death, unstable angina and non-fatal reinfarction) in the 53 patients with LV hypertrophy and only four events in the remaining 58 patients without LV hypertrophy (RR=2.45; CI=1.76–3.41; P<0.0001). The patients with concentric LV hypertrophy showed a higher incidence of events (64%) than patients with eccentric LV hypertrophy (32%, P<0.05) and patients with normal geometry and mass (6%, P<0.0001). Multivariate Cox regression model identified concentric geometry as the most powerful predictor of combined end-points ( χ 2=32.7, P<0.0001). Conclusions: An increased LV mass and concentric geometry resulted important independent markers of an adverse outcome in patients with a first, uncomplicated myocardial infarction and good LV function.