Elevated left ventricular mass boosts heart failure risk

Greater left ventricular mass identified on MRI is a better predictor of coronary artery disease-related death and heart failure compared to coronary artery calcium (CAC) scoring, reported authors of a multi-center study published in Radiology.

The Multi-Ethnic Study of Atherosclerosis (MESA) included a population-based sample of nearly 7,000 men and women. Lead author Nadine Kawel-Boehm, MD, and colleagues found patients with LV hypertrophy—or elevated left ventricular mass—had 4.3-times the risk of coronary artery disease-related death compared to those without.

"Our results provide further evidence and motivation for regular follow up and management of individuals with left ventricular hypertrophy," she said, in an RSNA statement. "A higher LV mass quantified by imaging may matter more in some instances than a high calcium score."

There is minimal research on predicting the long-term risk of cardiovascular events in ethnically diverse populations who exhibit LV hypertrophy on MRI, according to Kawel-Boehm, a senior staff radiologist at Hospital Graubünden in Chur, Switzerland.

"Previous studies have used ECG or echocardiography, which have lower sensitivity in the diagnosis of LV hypertrophy, and typically follow patients for only several years," she added. "The MESA study used MRI, which is the gold standard for quantifying LV mass, and had a long follow-up of 15 years."

The team included 6,814 patients (52% women) age 45-84 with no known heart disease in their study. Of them, 4,988 underwent a baseline cardiac MRI between 2000 and 2002.

After 15-year follow-up, 290 patients had a “significant” coronary heart disease (CHD) event, including 207 heart attacks, 95 CHD deaths, 57 patients with cardiovascular disease-related deaths and 215 patients with heart failure.

Upon statistical analysis, the researchers found that LV hypertrophy was an independent predictor of significant CHD events, including heart attack, coronary artery disease-related death and heart failure. Analysis also revealed that 22% of participants with LV hypertrophy had a significant CHD event, compared to 6% who did not have LV hypertrophy.

This suggests deaths related to coronary and non-coronary related cardiovascular causes were more closely associated with LV hypertrophy than CAC scoring performed with CT imaging, the authors wrote.

“In contrast to the widely used CAC score, which is not known to regress with medical therapy, elevated LV mass is potentially reversible with treatment, and individuals with the most elevated risk are in the upper 5% of the population, allowing physicians to target therapy to this group,” the researchers concluded. “Our results provide further evidence and motivation for aggressive treatment of individuals with LV hypertrophy.”