A prediction model for left ventricular mass in patients at high cardiovascular risk.

BACKGROUND: Left ventricular (LV) mass has a continuous relation with cardiovascular risk, and regression of LV mass induced by pharmacological treatment is associated with improved prognosis. Therefore, early identification of patients with a large LV mass is desired. We developed a model to predict LV mass in individual hypertensives at high cardiovascular risk. DESIGN AND METHODS: We analyzed data of 536 hypertensives with symptomatic extracardiac atherosclerotic disease or marked risk factors for atherosclerosis from a cross-sectional study in a tertiary referral center. LV mass was measured by cardiac MRI. We developed the prediction rule with multivariable linear regression analysis and stepwise backward elimination. Internal validation was assessed with bootstrap sampling to obtain an estimate of model performance (R²) that may be expected for new patients. RESULTS: Important predictors for LV mass included sex, height, body mass index, systolic blood pressure, and previous aneurysm of the abdominal aorta. R² of the prediction model was 45% after internal validation, which was considerably higher than the R² of previously reported models (range 1-38%). Addition of electrocardiography data showed limited improvement of the model performance (R²=47%). CONCLUSION: We present a prediction model for LV mass in hypertensives at high cardiovascular risk. After external validation, this model may be used in clinical practice to estimate LV mass for early identification of large LV mass. The predictions of the model may support appropriate medical care in the prevention of cardiovascular disease.

Differences in determinants of left ventricular mass assessed by cardiac magnetic resonance imaging across subjects with and without previous symptomatic atherosclerotic disease.

BACKGROUND: Most previous studies on determinants of left ventricular (LV) mass have used echocardiography, which is less accurate than cardiac MRI (CMR). Furthermore, studies that used CMR to study the determinants of LV mass were performed in the general population. However, determinants may differ between those with and without previous symptomatic events. We studied the relation between atherosclerotic risk factors and LV mass in subjects free from cardiac disease, yet with and without atherosclerotic disease elsewhere. METHODS: A CMR was performed in 531 hypertensive subjects with clinically manifest extra-cardiac atherosclerotic disease or marked risk factors for atherosclerosis. In all subjects information on atherosclerotic risk factors was collected. Multivariable linear regression was used to study the relation of risk factors with LV mass. Interaction was evaluated with multiplicative interaction terms. RESULTS: Overall, male gender, weight, height, systolic blood pressure, albuminuria, current smoking, and a history of abdominal aortic aneurysm (AAA) were related to an increased LV mass. In subjects without a history of symptomatic atherosclerotic disease, gender, weight, height and systolic blood pressure were related to LV mass. In addition to these risk factors, albuminuria, current smoking and a history of AAA were related to LV mass in subjects with a history of symptomatic atherosclerotic disease. CONCLUSION: Our study points towards differences in risk factor relations across populations with and without symptomatic atherosclerotic disease. The observed relationship between cardiovascular risk factors and LV mass re-emphasizes the importance of adequate treatment of modifiable risk factors in the prevention of cardiovascular disease.

Relation of common carotid intima-media thickness with left ventricular mass caused by shared risk factors for hypertrophy.

BACKGROUND: It is unclear whether the relationship between common carotid intima-media thickness (cCIMT) and left ventricular mass (LVM) is due to shared risk factors for atherosclerosis or for hypertrophy. METHODS: In 525 hypertensive subjects at high cardiovascular risk, the relation of cCIMT to LVM and established vascular risk factors was studied. RESULTS: CCIMT was positively related to LVM. In a multivariable model including age, gender, height, weight, and LVM, a 1-g increase in LVM related to an increase in cCIMT of 1.6 microm (95% confidence interval, 0.8-2.4). After adjustment for atherosclerotic risk factors, notably previous stroke or transient ischemic attack, peripheral arterial disease, lipid-lowering medication, albuminuria and current smoking, the relation remained unchanged. In contrast, addition of systolic and diastolic blood pressure and hypertension treatment attenuated Beta for the relation between cCIMT and LVM with 19% to 1.3 microm (95% confidence interval, 0.2-2.2). CONCLUSION: The relationship between cCIMT and LVM may be due to risk factors for hypertrophy rather than for atherosclerotic factors in a considerable proportion of patients.