title: Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: the Cardiovascular Health Study.
abstract: OBJECTIVE
  Our aim in this study was to determine whether increased left ventricular mass (LVM) is a risk factor for the development of a reduced left ventricular ejection fraction (LVEF).
  
  
  BACKGROUND
  Prior studies have shown that increased LVM is a risk factor for heart failure but not whether it is a risk factor for a low LVEF.
  
  
  METHODS
  As part of the Cardiovascular Health Study, a prospective population-based longitudinal study, we performed echocardiograms upon participant enrollment and again at follow-up of 4.9 +/- 0.14 years. In the present analysis, we identified 3,042 participants who had at baseline a normal LVEF and an assessment of LVM (either by electrocardiogram or echocardiogram), and at follow-up a measurable LVEF. The frequency of the development of a qualitatively depressed LVEF on two-dimensional echocardiography, corresponding approximately to an LVEF <55%, was analyzed by quartiles of baseline LVM. Multivariable regression determined whether LVM was independently associated with the development of depressed LVEF.
  
  
  RESULTS
  Baseline quartile of echocardiographic LVM indexed to body surface area was associated with development of a depressed LVEF (4.8% in quartile 1, 4.4% in quartile 2, 7.5% in quartile 3, and 14.1% in quartile 4 [p < 0.001]). A similar relationship was seen in the subgroup of participants without myocardial infarction (p < 0.001). In multivariable regression that adjusted for confounders, both baseline echocardiographic (p < 0.001) and electrocardiographic (p < 0.001) LVM remained associated with development of depressed LVEF.
  
  
  CONCLUSIONS
  Increased LVM as assessed by electrocardiography or echocardiography is an independent risk factor for the development of depressed LVEF.
authors.affiliation: Heart Failure Research Unit, Donald W. Reynolds Cardiovascular Clinical Research Center, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. mark.drazner@utsouthwestern.edu
authors.forename: Mark H
authors.initials: MH
authors.lastname: Drazner
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Rame
authors.forename: Emily K
authors.initials: EK
authors.lastname: Marino
authors.forename: John S
authors.initials: JS
authors.lastname: Gottdiener
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Julius M
authors.initials: JM
authors.lastname: Gardin
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dries
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
mesh_terms: D000368:Aged; D001830:Body Surface Area; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*