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Aortic and vascular disease
Original research article
Impact of the left ventricular mass index on the outcomes of severe aortic stenosis
  1. Eri Minamino-Muta1,
  2. Takao Kato1,
  3. Takeshi Morimoto2,
  4. Tomohiko Taniguchi1,
  5. Moriaki Inoko3,
  6. Tetsuya Haruna3,
  7. Toshiaki Izumi3,
  8. Shoichi Miyamoto3,
  9. Eisaku Nakane3,
  10. Kenichi Sasaki3,
  11. Moritoshi Funasako3,
  12. Koji Ueyama3,
  13. Shinichi Shirai4,
  14. Takeshi Kitai5,
  15. Chisato Izumi6,
  16. Kazuya Nagao7,
  17. Tsukasa Inada7,
  18. Eiji Tada8,
  19. Akihiro Komasa8,
  20. Katsuhisa Ishii8,
  21. Naritatsu Saito1,
  22. Ryuzo Sakata9,
  23. Kenji Minatoya10,
  24. Takeshi Kimura1
  1. 1 Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
  2. 2 Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
  3. 3 Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
  4. 4 Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
  5. 5 Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
  6. 6 Department of Cardiology, Tenri Hospital, Tenri, Japan
  7. 7 Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
  8. 8 Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
  9. 9 Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
  10. 10 Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
  1. Correspondence to Dr Takao Kato, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan; tkato75{at}kuhp.kyoto-u.ac.jp

Abstract

Objective To elucidate the factors associated with high left ventricular mass index (LVMI) and to test the hypothesis that high LVMI is associated with worse outcome in severe aortic stenosis (AS).

Methods We analysed 3282 patients with LVMI data in a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan. The management strategy, conservative or initial aortic valve replacement (AVR), was decided by the attending physician. High LVMI was defined as LVMI >115 g/m2 for males and >95 g/m2 for females. We compared the risk between normal and high LVMI in the primary outcome measures compromising aortic valve-related death and heart failure hospitalisation.

Results Age was mean 77 (SD 9.6) years and peak aortic jet velocity (Vmax) was 4.1 (0.9) m/s. The factors associated with high LVMI (n=2374) included female, body mass index ≥22, absence of dyslipidemia, left ventricular ejection fraction <50%, Vmax ≥4 m/s, regurgitant valvular disease, hypertension, anaemia and end-stage renal disease. In the conservative management cohort (normal LVMI: n=691, high LVMI: n=1480), the excess adjusted 5-year risk of high LVMI was significant (HR: 1.53, 95% CI 1.26 to 1.85, p<0.001). In the initial AVR cohort (normal LVMI: n=217, high LVMI: n=894), the risk did not differ significantly between the two groups (HR: 0.96, 95% CI 0.60 to 1.55, p=0.88). There was a significant interaction between the initial treatment strategy and the risk of high LVMI (p=0.016).

Conclusions The deleterious impact of high LVMI on outcome was observed in patients managed conservatively, but not observed in patients managed with initial AVR.

Trial registration number UMIN000012140; Post-results.

  • aortic stenosis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartjnl-2016-311022

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    Footnotes

    • Contributors TakaK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: EM-M, TakaK, TM, TT and TakeK. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: EM-M, TakaK, TM and TK. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: EM-M, TakaK, TM and TT. Administrative, technical or material support: TK. Study supervision: TM and TK.

    • Competing interests None declared.

    • Ethics approval The institutional review board of Kyoto University and each participating centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.