Prognostic value of left ventricular mass index in patients with mild and moderate aortic stenosis

Aim. To study the prognostic value of Left Ventricular Mass (LVM) with asymptomatic aortic stenosis (AS) in a long-term outpatient study, as well as the effect of the LVM on major cardiovascular events (CVe).

Material and methods. Cox regression analysis was used to evaluate the effect of an echocardiographically detected increased LVM on the frequency of major cardiovascular diseases: a serious cardiovascular event; events related to the aortic valve — combined aortic valve replacement, congestive heart failure due to AS, and ischemic cardiovascular events — nonfatal myocardial infarction, non-hemorrhagic stroke, coronary revascularization, hospitalization due to unstable angina. The study included 165 patients with average age of 67 years; 39,6% of women had asymptomatic form of mild and moderate AS. Patients were selected with asymptomatic, mainly moderate AS, without diabetes, cardiovascular or renal pathologies. Patients were observed for 4 years.

Results. At the beginning of the study, the LVM index was 45,9±14,9 g/ m², and the peak velocity in the aorta was 3,9±0,54 m/s. During the observation, 58 major CVE were indentified. In Cox regression analysis, 1 standard deviation (15 g/m²) above the initial level of the LVM index determines the predicted increase in risk by 12% for major CVE, 28% for ischemic CVE, 34% for cardiovascular mortality and 23% for all cause mortality and hospitalization for heart failure (all p<0,01). A higher LVM index was consistently associated with CVE risk increase from 13% to 61% (all p<0,01) regardless of age, gender, body mass index, LV ejection fraction, concentricity and presence of concomitant hypertension.

Conclusion. A higher LVM index is independently associated with increased cardiovascular morbidity and mortality with progression of AS.

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