Prognostic value of left ventricular mass normalized to different body size indexes: Findings from the PAMELA population

Aim: We estimated the risk of cardiovascular and all-cause mortality associated with left ventricular hypertrophy (LVH) as assessed by left ventricular mass (LVM), normalized by various indexation methods in 1716 representatives of the general population of Monza, enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study. Methods: LVH was defined according to four sex-specific criteria derived from the upper limits of normality for LVM index in the healthy normotensive fraction of the Pressioni Arteriose Monitorate E Loro Associazioni population. Death certificates were collected over an average 211 months of follow-up. Results: During follow-up, 89 fatal cardiovascular events and 264 all-cause deaths were observed. LVH prevalence rates in the whole population ranged from 14.2% [LVM/body surface area (BSA)] to 18.0% (LVM/height^2.7). Adjusted risk (for baseline covariates, including ambulatory blood pressure) of cardiovascular mortality was increased in patients with LVH, regardless of the indexation type: LVH/BSA [hazard ratio 3.19, 95% confidence interval (CI) 2.02-5.06, P1.7 (hazard ratio 2.39, 95% CI 1.51-3.78, P=0.0002), LVH/height^2.7 (hazard ratio 2.38, 95% CI 1.50-3.76, P=0.0002), LVH/height (hazard ratio 2.28, 95% CI 1.44-3.60 P=0.0004). Similar findings were observed for all-cause mortality and when LVM was assessed as a continuous variable. The fraction of patients (5%) classified into the LVH group by height^2.7, but not by BSA, had a mild increased LVM index and showed no increased risk. Conclusions: LVH, irrespective of indexation methods for LVM, confers an increased risk of cardiovascular and all-cause mortality in the general population. LVH, detected by height-based indexes, but not by BSA-based criteria, was not associated with increased mortality; this finding, however, was based on a small group of patients and will deserve further investigations.