Author + information
- Received February 13, 2017
- Revision received April 7, 2017
- Accepted April 8, 2017
- Published online March 5, 2018.
- Ahmed Abdi-Ali, MDa,b,
- Robert J.H. Miller, MDa,b,
- Danielle Southern, MScc,
- Mei Zhang, MScc,
- Yoko Mikami, MD, PhDa,
- Merril Knudtson, MDb,c,
- Bobak Heydari, MD, MPHa,b,
- Andrew G. Howarth, MD, PhDa,b,
- Carmen P. Lydell, MDa,d,
- Mathew T. James, MDb,c,
- Stephen B. Wilton, MD, MScb,c and
- James A. White, MDa,b,d,∗ ()
- aStephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- bDepartment of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
- cO’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- dDepartment of Radiology, University of Calgary, Calgary, Alberta, Canada
- ↵∗Address for correspondence:
Dr. James A. White, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, Suite 0700, SSB, Foothills Medical Centre, 700-1403 29 ST NW, Calgary, Alberta T2N 2T9, Canada.
Objectives The goal of this study was to assess associations between left ventricular (LV) mass, all-cause mortality, and need for revascularization in patients undergoing coronary angiography.
Background LV hypertrophy is associated with adverse cardiovascular outcomes in healthy subjects. However, its influence in those with known or suspected coronary artery disease is poorly understood.
Methods A total of 3,754 patients (mean age 59.3 ± 13.1 years) undergoing invasive coronary angiography and cardiac magnetic resonance (CMR) (mean interval 1.0 ± 1.5 months) were studied. LV mass and volumes were determined from cine images and indexed to body surface area. Analyses were adjusted for CMR variables, medical comorbidities, and severity of coronary artery disease (Duke Jeopardy Score) and were stratified to LV function.
Results At a median of 44.9 months, 315 patients (8.4%) died and 168 patients (4.5%) underwent revascularization. Multivariable analysis showed that each 10 g/m2 increase in LV mass index was associated with a 6% greater risk of mortality (hazard ratio: 1.06; 95% confidence interval [CI]: 1.01 to 1.11; p = 0.02) and a 10% greater need for revascularization (hazard ratio: 1.10; 95% CI: 1.04 to 1.17; p < 0.01). According to pre-defined thresholds, moderate to severe hypertrophy was associated with a 1.7-fold risk of mortality (95% CI: 1.2 to 2.3) and 1.8-fold need for revascularization (95% CI: 1.18 to 2.67). These findings were predominantly observed in those with a left ventricular ejection fraction >35% with respective hazard ratios of 2.93 (95% CI: 1.92 to 4.47) and 2.20 (95% CI: 1.21 to 3.98).
Conclusions LV mass index is an independent predictor of all-cause mortality and need for revascularization. This finding establishes relevance for LV mass measurements in clinical decision-making surrounding both the need and timing of revascularization in this population.
APPROACH was initially funded with a grant from the W. Garfield Weston Foundation. The ongoing operation of the APPROACH project has been made possible by support from Alberta Health Services (Calgary Zone, Edmonton Zone), Libin Cardiovascular Institute of Alberta, and Mazankowski Alberta Heart Institute. The APPROACH initiative has also received contributions from Alberta Health and Wellness and several industry sponsors (Merck Frosst Canada Inc., Eli Lily Canada Inc., and Servier Canada Inc.) to support the basic infrastructure of this cardiac registry initiative. Dr. White has received funding from the Calgary Health Trust; is supported by an Early Investigator Award from the Heart and Stroke Foundation of Alberta; is Chief Medical Officer of Cohesic Inc., in which he holds shares; and has received grant support from Circle Cardiovascular Inc. Dr. Wilton has received grant support from St. Jude Medical and Alberta Health Services; and has served as a consultant for Boehringer-Ingelheim and Arca Biopharma. Dr. James is supported by a KRESCENT New Investigator Award, a joint initiative of the Kidney Foundation of Canada, the Canadian Institute of Health Research and the Canadian Society of Nephrology, and by a Canadian Institutes of Health Research New Investigator Award. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Abdi-Ali and Miller are joint first authors.
- Received February 13, 2017.
- Revision received April 7, 2017.
- Accepted April 8, 2017.
- 2018 American College of Cardiology Foundation
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