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Beyond left ventricular mass: the prognostic power of left ventricular shape
  1. Cesare Cuspidi1,2,
  2. Marijana Tadic3,
  3. Carla Sala4
  1. 1Department of Health Science, University of Milano-Bicocca, Milano, Italy
  2. 2Istituto Auxologico Italiano IRCCS, Milano, Italy
  3. 3University Clinical Hospital Centre “Dragisa Misovic”, Belgrade, Serbia
  4. 4Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy
  1. Correspondence to Professor Cesare Cuspidi, Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, Meda 20036, Italy; cesare.cuspidi{at}unimib.it

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Introduction

In recent years, our knowledge about the mechanisms leading to acute and chronic changes in cardiac morphology and function has been progressively expanding.

Nowadays, human studies on cardiac remodelling mostly rely on a variety of non-invasive, rapidly evolving imaging techniques. Standard echocardiography is an established, cost-effective, available cardiac imaging technique currently applied to detect and quantify the severity of morphological and functional alterations of the heart. The pivotal role of echocardiography has been further powered by new ultrasonographic instruments, primarily two-dimensional and three-dimensional speckle tracking imaging devices which provide a comprehensive assessment of myocardial mechanics.

Nuclear and MRI techniques are reliable, highly reproducible methods increasingly applied in clinical and research settings. In particular, cardiac MRI has the undisputed potential to generate high-quality images of the heart at much higher resolution than echocardiographic and nuclear techniques.

Since the early 1990s, prospective epidemiological studies have consistently shown that echocardiographic left ventricular hypertrophy (LVH) is a reliable marker of cardiac remodelling, independently associated to cardiovascular morbidity and mortality. The published Heart1 manuscript, reports the results of a longitudinal investigation addressing the prognostic significance of changes in left ventricular (LV) shape, as assessed by cardiac MRI in a large population-based sample free of known cardiovascular disease enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Before commenting these findings in detail, some general considerations on available evidence in this research field may be useful.

In a pioneering paper published at the beginning of the 1990s, Levy et al2 provided the first general population-based evidence that LV mass (LVM) estimated by M-mode echocardiography had a prognostic value beyond that conveyed by conventional cardiovascular risk factors. The authors documented a significant relation between LVM and incident cardiovascular disease as well as cardiovascular and all-cause mortalities in 3220 subjects participating in the Framingham Heart Study. In …

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