MESA: LV Mass Predicts Heart Failure, Worth Including in Echo Risk Assessment

Increased left ventricular mass in people initially without heart disease emerged as a strong and independently significant risk factor for subsequent heart failure in an analysis from a prominent longitudinal study, one that also saw a relationship between LV mass/volume ratio and risk of later coronary-disease events and stroke [1].

The findings support the routine measurement of LV mass during echocardiographic assessment for suspected heart disease, "especially in patients who may be at increased risk, such as those with longstanding hypertension or diabetes or who smoke or have other cardiovascular risk factors," Dr David A Bluemke (National Institutes of Health Clinical Center, Bethesda, MD) told heartwire.

Bluemke, lead author for the study appearing in the December 16/23, 2008 issue of the Journal of the American College of Cardiology, observed that LV mass "is not routinely assessed at echo labs but is routinely available." In the current analysis, it was measured with cardiac MRI, but the findings should also apply to LV mass by echocardiography.

An increased LV mass-volume ratio indicates an LV mass that is disproportionately large compared with LV volume and therefore a "concentric" remodeling pattern, which is characteristic of the form of LV hypertrophy that can follow from longstanding hypertension, observed Bluemke.

Echocardiographic assessment of LV mass has grown increasingly accurate and should be more widely available than cardiac MR and easier to perform, he said. "We know that the high-risk group is really the top 5%, so that becomes an interesting cutoff [for discriminating increased LV mass] that echocardiography can now probably achieve."

Bluemke DA, Kronmal RA, Lima JAC, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events. The MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol 2008; 52:2148-2155. doi:10.1016/j.jacc.2008.09.014