Prognostic implications of the compensatory nature of left ventricular mass in arterial hypertension

Objective To test whether inappropriate echocardiographic left ventricular (LV) mass (i.e. higher than predicted by individual body size, sex and card iac load [Delta %LVM]) is associated with an increased rate of cardiovascul ar events, and whether values of LV mass lower than appropriate confer prot ection. Design Prospective, longitudinal. Setting Institutional, hospital outpatient clinic. Patients A total of 294 hypertensive patients, 84 with inappropriate and 21 with low LV mass (lower than appropriate). Main outcome measures Cardiovascular fatal and nonfatal events. Results Baseline Delta %LVM was higher in patients with follow-up total (n = 50) or fatal (n = 14) events than in event-free survivors (all P < 0.0001 ) and predicted events independently of age and systolic pressure (all P < 0.0001), Although the performance was not better than with use of more trad itional definition of LV hypertrophy, Delta %LVM remained a predictor even in the subgroup of 126 patients (32 total events, 13 deaths) with clear-cut LV hypertrophy (P < 0.009), Patients with low LV mass exhibited supranorma l LV chamber and midwall function, slightly higher heart rate and higher ca rdiac index (all P < 0.01). These patients had the same rate of events as t hose with appropriate LV mass. Conclusions In hypertensive patients, increase in LV mass beyond values req uired to compensate cardiac workload at a given body size and sex predicts cardiovascular risk independently of age and blood pressure, in the whole p opulation as well as in the subset of patients with LV hypertrophy. Hyperte nsive patients with levels of LV mass lower than needed to compensate cardi ac workload exhibit hyperdynamic circulatory status and the same risk patte rn as patients with higher values of LV mass, possibly due to activation of the sympathetic system. (C) 2001 Lippincott Williams & Wilkins.