title: Prognostic effect of inappropriately high left ventricular mass in asymptomatic severe aortic stenosis.
abstract: OBJECTIVE
  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.
authors: Department of Cardiology, Villa Bianca Hospital, Trento, Italy. gcioffi@villabiancatrento.it
authors: Giovanni
authors: G
authors: Cioffi
authors: Pompilio
authors: P
authors: Faggiano
authors: Enrico
authors: E
authors: Vizzardi
authors: Luigi
authors: L
authors: Tarantini
authors: Dana
authors: D
authors: Cramariuc
authors: Eva
authors: E
authors: Gerdts
authors: Giovanni
authors: G
authors: de Simone
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality / Q000473:pathology*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis