Download appendix - JACC: Cardiovascular Imaging

Online Appendix for the following JACC: Cardiovascular Imaging paper
TITLE: Left Ventricular Mass Assessed by Echocardiography and Cardiac Magnetic
Resonance, Cardiovascular Outcomes, and Medical Practice
AUTHORS: Anderson C. Armstrong, MD, MSc, Samuel Gidding, MD, Ola Gjesdal, MD, PhD,
Colin Wu, PhD, David A. Bluemke, MD, PhD, MsB, João A. Lima, MD, MBA
APPENDIX
Online Table 1. Longitudinal studies using Echocardiography to estimate LVM as predictor of clinical outcomes
Mean
Author/Year
Population
n
Hypertrophy definition (LVMi)
Follow-up
Levy16
1990
FHS, >40 yrs, no CVD
3,220
4 years
1992
CCHDR; cardiac cath for presumed CAD , EF>45%,
785
4 years
>2 SD in reference group
> 131g/m2 for men;
Ghali7
> 100g/m2 for women
> 100 g/m2 in females,
Foley21
Liao23
1995
6 months survivors from ESRD therapy
433
41 months
> 131 g/m2 in males
1995
African-Americans underwent cath for presumed CAD
1,089
5 years
1995
Uncomplicated hypertensive patients
151
10 years
>131 g/m2 in men; >100 g/m2 in women
LVMi > 134g/m2 for men;
Muiesan9
Muiesan28
> 110g/m2 for women
1998
Brescia Study; uncomplicated hypertensive patients
151
PIUMA; essential hypertensive before therapy , average
Verdecchia8
Quiñones5
Sundström17
1998
10 years
> 97th percentile partition of LVMi
1217 patient>125 g/m2
430
48.2years
years
2000
SOLVD ; CHF patients
1,172
1 year
not used in analysis
2001
men at age 70, living in Sweden (Uppsala)
475
5.2 years
≥150 g/m2
2001
MAVI; hypertensive, no CVD, age ≥50
1,033
3 years
LVM/BSA >125 g/m2 and
Verdecchia18
LVM/height2.7 >51.0 g/m2.7
1
Verdecchia19
Zoccalli12
de Simone6
Tsang25
2001
PIUMA; untreated hypertensive without CVD
2,363
5 years
>125 g/m2
2001
CREED; ESRD on dialysis
254
29 months
> 97.5th percentile in reference
2002
MAVI; hypertensive, age ≥50, no CVD or type 1 diabetes
1,019
35 months
>28% excess in relation to reference population
2003
age 65 years, without CVD, from USA (Minnesota)
1,160
3.8 years
LVM/height ≥120 g/m
2004
SHS; American Indians, age 59 +/-8 years
2,193
3.1 years
> 104 g/m2 in women;
Okin24
Zoccali31
116g/m2 in men
2004
CREED; ESRD on dialysis
161
29 months
941
4.6 years
Not used
>116 g/m2 in men;
LIFE; aged 55 to 80 years, with essential hypertension and
Devereux27
2004
> 104 g/m2 in women
EKG showing LVH, during treatment
>95th percentiles of sex-specific
de Simone10
2005
MAVI; hypertensive, age ≥50, no CVD
1,019
35 months
normal distributions or prognosis
>95th percentiles of sex-specific distribution a
de
Simone11
2005
SHS; American Indians, 47 - 80 years, no CVD
2,400
86 months
reference sample for each index
≥110 g/m2 in women;
Eguchi4
2007
uncomplicated hypertensive Japanese
400
63 months
≥134 g/m2 in men
> 28% above the predicted based on a reference
Muiesan29
2007
Uncomplicated hypertensive patients
436
60 months
sample
LVMi >50 g/m2.7 in men;
hypertension and LVH by echocardiography, aged 52 ± 10
Pierdomenico30
2008
387
2 years
>47 g/m2.7 in women
years
> 28% above the predicted based on a reference
de Simone15
2008
CHS; no MI, AFib, or HF
2,078
10 years
sample
> 115 g/m2 for men;
Verma20
Yasuno26
2008
VALIANT; CHF post-MI patients
603
24.7 months
> 95 g/m2 for women
2009
CASE-J; high-risk Japanese hypertensive
1,447
3.3 years
>=125 g/m 2
2,604
14.4 years
cut-off value of 105 g/m2 (highest Youden’s index)
CCC; ≥35 years Chinese subjects, without previous
Lai22
2011
cardiovascular events
CAD – coronary artery disease; CHD – congestive heart failure; MI - myocardial infarction; ESRD - end-stage renal disease; FHS - Framingham
Heart Study; CV death - cardiovascular death; CVD – cardiovascular disease; CHF - congestive heart failure; TIA - transient ischemic attack;
CCHDR - Cook Count Heart Disease Registry; CRV - coronary revascularization; PIUMA - The Progetto Ipertensione Umbria Monitoraggio
Ambulatoriale; UHC - University Hospital of Catanzaro; CHS - Cardiovascular Health Study; SOLVD - Studies of Left Ventricular Dysfunction;
MAVI - The Massa Ventricolare sinistra nell’Ipertensione study; CREED - the Cardiovascular Risk Extended Evaluation in Dialysis study; POAD –
peripheral occlusive arterial disease; AFib - atrial fibrillation; LIFE - Losartan Intervention For Endpoint Reduction in Hypertension study; IHD Ischemic heart disease; LVH – LVH; AFib - atrial fibrillation; VALIANT – the valsartan in acute myocardial infarction study; CASE-J - Candesartan
Antihypertensive Survival Evaluation in Japan CCC - Chin-Shan Community Cardiovascular Cohort Study.
2
Online Table 2. Longitudinal studies using CMR to estimate LVM as predictor of clinical outcomes
Hypertrophy definition
Publication
Population
n
Mean Follow-up
(LVMi)
MESA
Bluemke3, 2008
4,968
4 years
not used in analysis
2,194
926 days
Not used in analysis
5,004
4.1 years
Not used in analysis
Known/suspected CAD
Krittayaphong13,
Brumback1, 2010
2009
referred to CMR
MESA
> 95th perc in the
Chirinos2, 2010
Jain14, 2011
MESA
5,004
4.8 years
reference sample
MESA
4,965
5.8 years
not used in analysis
LVMi – LVM index; CAD – coronary artery disease; CHF – Congestive heart failure; MI - myocardial infarction; MESA (Multiethnic Study of Atherosclerosis ) white, black, Hispanic, and Chinese adults free of overt cardiovascular disease, aged 45 to 84 years from 6 US communities; CMR – cardiac magnetic
resonance.
3
Online Figure 1. Hazards Ratios and 95% Confidence Interval for longitudinal studies using Echocardiography to estimate LVM or LVMi as predictor of
clinical outcomes.
Publication
de Simone10, 2005
de
Simone15,
2008
Eguchi4, 2007
Levy16, 1990
Sundström17, 2001
1998
Outcomes
Predictor
Not used
LVM (71g)
BSA
LVMi (38 g/m2)
Height
Composite 1
LVMi (25 g/m2.13)
Height2.7
LVMi (19 g/m2.7)
Height2.7
BSA
not used
BSA
HF MI-independent
Composite 2
LVMi
LVMi (diabetic)
LVMi (no diabetic)
MEN - Composite 3
LVMi ( 50g/m)
MEN - CV death
LVMi (per 50g/m)
MEN - death
LVMi (per 50g/m)
WOMEN - Composite 3
LVMi (per 50g/m)
WOMEN - CV death
LVMi (per 50g/m)
WOMEN - death
LVMi (per 50g/m)
death
LVM
CV hospitalization
LVM
death
LVMi
CV death
LVMi
All cause morbidity
LVMi
CV morbidity
LVMi
LVM (baseline)
BSA
Composite 4
Verdecchia18, 2001
BSA
Composite 5
LVMi (per 39g)
Verdecchia19, 2001
BSA
stroke, TIA
LVMi (per 29g/m2)
Composite 6
LVMi (10gm/m2)
death
LVMi (10gm/m2)
CV death
LVMi (10gm/m2)
Verma20, 2008
BSA
BSA
Zoccalli12, 2001
Height2.7
Hazard Ratios (95% Confidence Interval)
LVMi (43 g/m)
Height2.13
height
Quiñones5, 2000
Verdecchia8,
Normalization
Death or HF hospitalization
LVMi (10gm/m2)
All cause death
LVMi (per 1 g/m2)
CV death
LVMi (per 1 g/m2)
CV events
LVMi (per 1 g/m2)
All cause death
LVMi (per 1 g/m2.7)
CV death
LVMi (per 1 g/m2.7)
CV events
LVMi (per 1 g/m2.7)
Composite 1 - fatal and nonfatal cardiovascular events, including sudden death and other cardiovascular deaths, myocardial infarction, stroke,
heart failure requiring hospitalization, renal failure requiring dialysis, documented angina, transient ischemic attack, or peripheral occlusive
arterial disease verified by angiography; Composite 2 - CV death, Ischemic heart disease, CHF, End-stage renal disease, peripheral arterial
disease, and stroke; Composite 2 - coronary heart disease, congestive heart failure, stroke or transient ischemic attack and intermittent
claudication; Composite 4 - new-onset coronary artery disease, stroke, transient cerebral ischemic attack, symptomatic aortoiliac occlusive
disease verified at angiography, thrombotic occlusion of a retinal artery documented at fluoroangiography, progressive heart failure requiring
hospitalization, and renal failure requiring dialysis; composite 5 - fatal and nonfatal MI, sudden cardiac death, fatal and nonfatal stroke, other
cardiovascular deaths, all-cause death, severe heart failure requiring hospitalization and severe renal failure requiring dialysis; TIA - Transient
ischemic attack; Composite 6 - end point of death from cardiovascular causes, reinfarction, heart failure, stroke, or resuscitation after cardiac
arrest
4
Online Figure 2. Hazards Ratios and 95% Confidence Interval for longitudinal studies using Echocardiography to estimate LVH as predictor of
clinical outcomes.
Outcomes
Predictor
de Simone6
Publication
2002
Composite 1
de Simone11
2005
Composite 2
de Simone15
2008
Foley21
1995
HF MI-indep
overall mortality
death after 2years
Ghali7
1992
LVH (excess)
LVHa
LVHb
LVHc
LVHd
LVHe
LVHf
LVH (excess)
LVH
LVH
LVH with CAD
LVH no CAD
LVH with CAD
LVH no CAD
LVH
LVH
LVH (with CAD)
LVH (no CAD)
LVH
LVH (with CAD)
LVH (no CAD)
LVH
LVH
LVH
LVH
LVH
LVH
LVH
LVH
LVH
All cause death
Cardiac Death
Lai22
2011
CHD and stroke
All cause death
Liao23
1995
Cardiac death
Okin24
2004
Sundström17
2001
Tsang25
Verdecchia19
Yasuno26
2003
2001
2009
All-Cause death
CV death
All cause death
CV death
All morbidity
CV morbidity
Composite 3
stroke, TIA
Composite 4
Hazard Ratios (95% Confidence Interval)
Composite 1 - fatal or nonfatal myocardial infarction, sudden death, fatal or nonfatal stroke, other cardiovascular deaths, severe heart failure
requiring hospitalization, severe renal failure requiring dialysis, documented angina, transient ischemic attack, and peripheral occlusive arterial
disease verified by angiography; HF – heart failure; MI-indep – myocardial infarct independent; CAD – coronary artery disease; CHD - coronary
heart disease; Composite 2: Fatal/nonfatal coronary heart disease, stroke, congestive heart failure, other cardiovascular disease. Composite 3 myocardial infarction (MI), coronary revascularization, atrial fibrillation (AF), congestive heart failure (CHF), transient ischemic attack (TIA),
stroke, or cardiovascular death; TIA - Transient ischemic attack; Composite 4 - sudden death, which is unexpected death that occurs within 24 h
without external causes; cerebrovascular events including stroke or transient ischemic attack; cardiac events including heart failure, angina
pectoris, or acute myocardial infarction; renal events including sCr more than or equal to 4.0 mg/dl, doubling of the sCr (however, sCr 2.0 mg/dl
is not regarded as an event), or end-stage renal disease; and vascular events including dissecting aortic aneurysm or arteriosclerotic occlusion
of a peripheral artery.
LVHa – hypertrophy defined by non-indexed LVM; LVHb– hypertrophy defined by LVM indexed by BSA; LVHc– hypertrophy defined by LVM
indexed by BSA1.5; LVHd – hypertrophy defined by LVM indexed by height; LVHe– hypertrophy defined by LVM indexed by height2.7; LVHf–
hypertrophy defined by LVM indexed by height2.13. LVHa to LVHf refer to the whole population included in the study.
5
Online Figure 3. Hazards Ratios and 95% Confidence Interval for longitudinal studies using Echocardiography to estimate LVM and LVH status
serial changes as predictor of clinical outcomes.
Publication
Devereux27
Normalization
2004
BSA
Outcomes
Composite 1
CV death
MI
stroke
All cause death
Composite 1
CV death
MI
stroke
All cause death
Muiesan9
1995
BSA
Muiesan28
1998
height2.7
Muiesan29
2007
height2.7
Nonfatal CV
events
composite 3
Pierdomenico30 2008
height2.7
Composite 4
Composite 2
Verdecchia8
1998
BSA
Composite 5
Yasuno26
2009
BSA
composite 6
Zoccali31
2004
height2.7
Composite 7
Predictor
LVMi decrease of 1
standard deviation
Hazard Ratios (95% CI)
LVH (absence vs.
presence)
LVH maintained
LVH regression
LVH maintained
LVH regression
LVH (develop & persist)
LVH regression
LVMi decrease†
LVM decrease
LVH regression
LVH absence‡
LVH development¥
LVH¥
LVMi increase§
CV – cardiovascular; MI – myocardial infarct; Composite 1 - endpoint of CV death, myocardial infarction, and stroke; composite 2 - stroke, MI,
angina, HF; composite 3 - sudden death, fatal and nonfatal stroke, transient cerebral ischemic attack, fatal and nonfatal myocardial infarction,
new-onset angina requiring hospitalization, progressive heart failure requiring hospitalization, coronary artery bypass or angioplasty, carotid
endarterectomy, and renal failure requiring dialysis; composite 4 - fatal and non-fatal myocardial infarction, coronary revascularization, heart
failure requiring hospitalization, and fatal and non-fatal stroke; composite 5 - new-onset coronary artery disease, stroke, transient cerebral
ischemic attack, symptomatic aortoiliac occlusive disease verified at angiography, thrombotic occlusion of a retinal artery documented at
fluoroangiography, progressive heart failure requiring hospitalization, and renal failure requiring dialysis; composite 6 - of sudden death,
cerebrovascular events, heart failure, angina pectoris, acute myocardial infarction, renal events or end-stage renal disease, and vascular events;
composite 7 - electrocardiographic-documented anginal episodes and myocardial infarction, heart failure, electrocardiographic-documented
arrhythmia, transient ischemic attacks, stroke, and other thrombotic events) and death after the second echocardiogram.
†Decrease
of 6.6g/m2.7; ‡ reference: persistence of LVH after 1 year; ¥ after 1 year; § 1 g/m2.7/month increase in an average of 18 months after
baseline.
6
Online Figure 4. Hazards Ratios and 95% Confidence Interval for longitudinal studies using CMR to estimate LVM as predictor of clinical outcomes.
Publication
Bluemke3
Brumback1
Normalization
Outcomes
2008
observed /
predicted
CHD
stroke
HF
2010
BSA
Height2
Height2.7
not used
Model 1
Model 2
CHD or stroke
All CVE
BSA
Hard CVE
death
All CVE
Chirinos2
2010
Height1.7
Hard CVE
death
All CVE
Height2.7
Hard CVE
death
Krittayaphong13
2009
BSA
Jain14
2011
Model 2
CV death/MI
MACE
CHD
Stroke
HF
CV disease
Predictor
Hazard Ratios (95% Confidence Interval)
LVMi
LVMi
LVMi (10%)
LVMi
LVMi
LVMi
LVM
LVMi
LVMi
LVMi
LVH
LVMi
LVH
LVMi
LVH
LVMi
LVH
LVMi
LVH
LVMi
LVH
LVMi
LVH
LVMi
LVH
LVMi
LVH
LVMi (10%)
LVMi (10%)
LVMi (1SD)
Model 1 - LV mass divided by 42.5 x (height in meters)1.88 for women, and LV mass divided by 51.4 x (height in meters)1.88 for men; Model 2 - 6.82 x (height in meters)0.561
x (weight in kilograms)0.608 for women, and 8.17 x (height in meters)0.561 x (weight in kilograms)0.608 for men; MACE: cardiac death or nonfatal myocardial infarction or
hospitalization due to heart failure or unstable angina, or life-threatening ventricular arrhythmia; CHD – coronary artery disease; LVMi – LVM index; HF – heart failure;
BSA – body surface area; CVE – cardiovascular events; LVH – LVH; CV – cardiovascular; MI – myocardial infarct; HF – heart failure.
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