Relation of left ventricular mass and concentric remodeling to extent of coronary artery disease by computed tomography in patients without left ventricular hypertrophy: ROMICAT study.
ABSTRACT Cardiac computed tomography allows for simultaneous assessment of left ventricular mass (LVM) and coronary artery disease (CAD). We aimed to determine whether LVM, LVM index (LVMi), and the left ventricular geometric pattern of concentric remodeling are associated with the extent of CAD in patients without left ventricular hypertrophy.
In 348 patients from the Rule Out Myocardial Infarction Using Computer Assisted Tomography trial, 64-slice computed tomography was performed and LVM measured at end-diastole. We used three LVM indexation criteria to obtain three cohorts: LVM indexed to body surface area by echocardiography (n = 337) and computed tomography criteria (n = 325), and by height (n = 326). The cohorts were subdivided into concentric remodeling and normal geometry. Extent of coronary plaque was classified based on a 17-segment model, treated as a continuous variable, and stratified into three groups: zero segment, one to four segments, and more than four segments.
Patients with more than four segments of coronary plaque had higher LVM (Delta12.8-15.1 g) and LVMi (Delta4.0-5.5 g/m and Delta2.2 g/m) than those without CAD (all P < or = 0.03). After multivariable adjustment, LVM and LVMi remained independent predictors of extent of coronary plaque, with 0.27-0.29 segments more plaque per 20 g increase of LVM (all P = 0.02), 0.32-0.34 segments more plaque per 10 g/m increase of LVMi (both P = 0.02), and 0.80 segments more plaque per 10 g/m increase of LVMi (P = 0.008). Concentric remodeling patients had 1.1-1.3 segments more plaque than those with normal geometry (all P < or = 0.05). Patients with more than four segments of plaque had two-fold increase in odds (all P < or = 0.05) of having concentric remodeling as compared with those without CAD.
Increased LVM, LVMi, and concentric remodeling are associated with a greater degree of coronary plaque burden in patients without left ventricular hypertrophy. These findings could provide an indication to intensify medical therapy in patients with subclinical CAD and hypertension.
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ABSTRACT: The authors investigated 3 important areas related to the clinical use of left ventricular mass (LVM): accuracy of assessments by echocardiography and cardiac magnetic resonance (CMR), the ability to predict cardiovascular outcomes, and the comparative value of different indexing methods. The recommended formula for echocardiographic estimation of LVM uses linear measurements and is based on the assumption of the left ventricle (LV) as a prolate ellipsoid of revolution. CMR permits a modeling of the LV free of cardiac geometric assumptions or acoustic window dependency, showing better accuracy and reproducibility. However, echocardiography has lower cost, easier availability, and better tolerability. From the MEDLINE database, 26 longitudinal echocardiographic studies and 5 CMR studies investigating LVM or LV hypertrophy as predictors of death or major cardiovascular outcomes were identified. LVM and LV hypertrophy were reliable cardiovascular risk predictors using both modalities. However, no study directly compared the methods for the ability to predict events, agreement in hypertrophy classification, or performance in cardiovascular risk reclassification. Indexing LVM to body surface area was the earliest normalization process used, but it seems to underestimate the prevalence of hypertrophy in obese and overweight subjects. Dividing LVM by height to the allometric power of 1.7 or 2.7 is the most promising normalization method in terms of practicality and usefulness from a clinical and scientific standpoint for scaling myocardial mass to body size. The measurement of LVM, calculation of LVM index, and classification for LV hypertrophy should be standardized by scientific societies across measurement techniques and adopted by clinicians in risk stratification and therapeutic decision making.JACC. Cardiovascular imaging 08/2012; 5(8):837-48. · 14.29 Impact Factor
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ABSTRACT: Lima and colleagues 1 describe a parallel independent association of the presence of coronary artery atherosclerosis, myocardial infarction, and left ventricular mass (LVM). Previous publications reporter 2 – 5 similar findings in somewhat different subsets of patients and they support the potential role of higher LVM as an independent predictor of adverse events in addition to coronary atherosclerosis and myocardial ischaemia. The current paper contributes to an expanding body of evidence that emphasizes the independent risk associated with the presence of higher LVM and intriguingly shows a strong relationship in patients with previous myocardial infarction. They also found that LVM and concentric remodelling are associated with a greater degree of cor-onary atheroma burden even in patients without LV hypertrophy that is also consistent with previously published data. 6,7 LVM may also be the consequence of a number of several con-founding risk factors such as hypertension, dyslipidaemia, obesity, smoking status, gender, aging, as well as the presence of previous myocardial infarction. 2,3,8 In this CORE320 substudy, the LVM index (LVMi) was associated with rest perfusion defects and the total ischaemic score (summed stress score ≥1) regardless of cardiovascular risk factors and ob-structive coronary artery disease (CAD), but not with the extent of reversible perfusion defects (summed difference score ≥1). Therefore, LVMi was only associated with the overall perfusion defects (summed stress score ≥1) when patients had previous infarcts. The authors theorize that this would be a consequence of the replacement of myocyte after cell damage or necrosis by fibrosis. They either ponder that interstitial fibrosis from chronic exposure to cardiovascular risk such as metabolic syndrome, obesity, hyperten-sion, and diabetes ultimately lead to replacement fibrosis in the later stages of disease, an consideration also made by previous authors. 7 – 12European Heart Journal – Cardiovascular Imaging 11/2014; · 3.67 Impact Factor
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ABSTRACT: Left ventricular hypertrophy (LVH) is an independent predictor of fatal and non-fatal cardiovascular events in hypertensive patients. Current guidelines for the management of hypertension are based on cardiovascular risk stratification. This study evaluated the possibility that an inexpensive, simple random, single-void urinary protein-to-creatinine ratio (UPCR) would be associated to left ventricular (LV) mass in a black African setting, and therefore direct appropriate management of these patients. We measured echocardiographic LV mass and a random spot UPCR in 34 untreated newly diagnosed hypertensive patients attending the cardiology consultation unit at the Yaoundé General Hospital. LV mass was indexed to height (in m(2.7)) to obtain the LV mass index (LVMI). A regression model was used to verify the independent association between UPCR and LVMI. The mean age of our patients was 52.65 years, and the mean systolic and diastolic blood pressures were 152.44 and 92.84 mm Hg, respectively. The prevalence of LVH was 41.2%. UPCR was higher in patients with LVH compared to those without (p = 0.043). There was a significant correlation between UPCR and LVMI (r = 0.581, p < 0.001). In the multiple linear regression model, UPCR was associated with LVMI independent of systolic blood pressure (p < 0.001). Random spot UPCR is associated with an increased LV mass and may be very useful in screening and guiding appropriate management of high-risk untreated hypertensive patients.Cardiorenal medicine. 04/2013; 3(1):57-62.