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  • Title: LV Mass Independently Predicts Mortality and Need for Future Revascularization in Patients Undergoing Diagnostic Coronary Angiography.
    Author: Abdi-Ali A, Miller RJH, Southern D, Zhang M, Mikami Y, Knudtson M, Heydari B, Howarth AG, Lydell CP, James MT, Wilton SB, White JA.
    Journal: JACC Cardiovasc Imaging; 2018 Mar; 11(3):423-433. PubMed ID: 28734928.
    Abstract:
    OBJECTIVES: The goal of this study was to assess associations between left ventricular (LV) mass, all-cause mortality, and need for revascularization in patients undergoing coronary angiography. BACKGROUND: LV hypertrophy is associated with adverse cardiovascular outcomes in healthy subjects. However, its influence in those with known or suspected coronary artery disease is poorly understood. METHODS: A total of 3,754 patients (mean age 59.3 ± 13.1 years) undergoing invasive coronary angiography and cardiac magnetic resonance (CMR) (mean interval 1.0 ± 1.5 months) were studied. LV mass and volumes were determined from cine images and indexed to body surface area. Analyses were adjusted for CMR variables, medical comorbidities, and severity of coronary artery disease (Duke Jeopardy Score) and were stratified to LV function. RESULTS: At a median of 44.9 months, 315 patients (8.4%) died and 168 patients (4.5%) underwent revascularization. Multivariable analysis showed that each 10 g/m2 increase in LV mass index was associated with a 6% greater risk of mortality (hazard ratio: 1.06; 95% confidence interval [CI]: 1.01 to 1.11; p = 0.02) and a 10% greater need for revascularization (hazard ratio: 1.10; 95% CI: 1.04 to 1.17; p < 0.01). According to pre-defined thresholds, moderate to severe hypertrophy was associated with a 1.7-fold risk of mortality (95% CI: 1.2 to 2.3) and 1.8-fold need for revascularization (95% CI: 1.18 to 2.67). These findings were predominantly observed in those with a left ventricular ejection fraction >35% with respective hazard ratios of 2.93 (95% CI: 1.92 to 4.47) and 2.20 (95% CI: 1.21 to 3.98). CONCLUSIONS: LV mass index is an independent predictor of all-cause mortality and need for revascularization. This finding establishes relevance for LV mass measurements in clinical decision-making surrounding both the need and timing of revascularization in this population.
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