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Heart 2011;97:301-307 doi:10.1136/hrt.2010.192997
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Valvular heart disease
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Original article
Prognostic effect of inappropriately high left ventricular mass
in asymptomatic severe aortic stenosis
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Giovanni Cioffi1,
Pompilio Faggiano2,
Enrico Vizzardi3,
Luigi Tarantini4,
Dana Cramariuc5,
Eva Gerdts5,
Giovanni de Simone6
+Author Affiliations
1. 1Department of Cardiology, Villa Bianca Hospital, Trento, Italy
2. 2Cardiology Unit, Spedali Civili, Brescia, Italy
3. 3Department of Cardiology, University of Brescia, Brescia, Italy
4. 4Department of Cardiology, Ospedale civile di Belluno, Belluno, Italy
5. 5Department of Heart Disease, Haukeland University Hospital, and Institute of Medicine, University of Bergen, Bergen,
Norway
6. 6Department of Clinical and Experimental Medicine, Federico II, University Hospital, Naples, Italy
Correspondence to
Dr Giovanni Cioffi, Department of Cardiology, Villa Bianca Hospital; Via Piave 78, 38100 Trento,
Italy; [email protected]
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Contributors GC had full access to all of the data in the study and takes responsibility for the integrity of the data and accuracy
of the data analysis. All authors have made a significant contribution in defining the study protocol, analysing the clinical data,
participating in the discussion of the results and critically reviewing the manuscript.
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Accepted 15 June 2010
Published Online First 18 August 2010
Abstract
Objectives In patients with aortic stenosis (AS) left ventricular (LV) myocardial growth may exceed individual needs to
compensate LV haemodynamic load leading to inappropriately high LV mass (iLVM), a condition at high risk of adverse
cardiovascular events. The prognostic impact of iLVM was determined in 218 patients with asymptomatic severe AS.
Methods iLVM was recognised when the measured LV mass exceeded 10% of the expected value predicted from height,
sex and stroke work (prognostic cut-off assessed by a specific ROC analysis). For assessment of outcome, the endpoint
was defined as death from all causes, aortic valve replacement or hospital admission for non-fatal myocardial infarction
and/or congestive heart failure.
Results At the end of follow-up (22+13 months) complete clinical data were available for 209 participants (mean age
75+11 years). A clinical event occurred in 81 of 121 patients (67%) with iLVM and in 26 of 88 patients (30%) with
appropriate LV mass (aLVM) (p<0.001). Event-free survival in patients with aLVM and iLVM was 78% vs 56% at 1-year,
68% vs 29% at 3-year and 56% vs 10% at 5-year follow-up, respectively (all p<0.01). Cox analysis identified iLVM as a
strong predictor of adverse outcome (Exp β 3.08; CI 1.65 to 5.73) independent of diabetes, transaortic valve peak
gradient and extent of valvular calcification. Among patients with LV hypertrophy, those with iLVM had a risk of adverse
events 4.5-fold higher than counterparts with aLVM.
Conclusions iLVM is common in patients with asymptomatic severe AS and is associated with an increased rate of
cardiovascular events independent of other prognostic covariates.