PROGNOSTIC VALUE OF LEFT-VENTRICULAR MASS IN UNCOMPLICATED ACUTE MYOCARDIAL-INFARCTION AND ONE-VESSEL CORONARY-ARTERY DISEASE

This study assesses the relative prognostic value of increased left ve ntricular (LV) mass compared with residual ischemic myocardium and ang iographic characteristics of the diseased vessel in 76 patients with u ncomplicated acute myocardial infarction associated with 1-vessel coro nary artery disease (CAD). All patients underwent symptom-limited trea dmill exercise testing, resting and dipyridamole echocardiography and coronary angiography before discharge, and were followed-up for 32 +/- 6 months. LV measurements were obtained in diastole according to the Penn convention. Measurements of LV maw were divided by body surface a rea to obtain LV mass index. A cut-off value of 135 g/m(2) body surfac e area for men and 112 g/m(2), for women was prospectively selected. T he individual effects of clinical, stress testing and angiographic var iables were evaluated by using the Cox regression model. Echocardiogra phic LV mass index was increased in 43 patients and normal in 33. Ther e was no intergroup difference with respect to baseline clinical and a ngiographic variables, ejection fraction and prevalence of stress-indu ced ischemia. During for low-up there were 23 cardiac events in the 43 patients with increased LV mass index and only 5 in the 33 with norma l LV mass index (p <0.001). No patient died or had nonfatal reinfarcti on among patients with normal LV mass. Cox survival analysis identifie d an increased LV mass index as the only independent predictor of card iac events (chi-square = 7.9; p <0.005; RR = 5.4). Thus, these data su ggest that LV mass is an important independent risk factor in patients with uncomplicated acute myocardial infarction associated with 1-vese l CAD.