Gerdts Eva, Rossebø Anne B, Pedersen Terje R, Cioffi Giovanni, Lønnebakken Mai Tone, Cramariuc Dana, Rogge Barbara P, Devereux Richard B
From the Department of Clinical Science, University of Bergen, Bergen, Norway (E.G., M.T.L.); Department of Cardiology (A.B.R.) and Centre for Preventive Medicine (T.R.P.), Oslo University Hospital Ullevaal, Oslo, Norway; Department of Cardiology, Villa Bianca Hospital, Trento, Italy (G.C.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (D.C., B.P.R.); and Department of Medicine, Weill Cornell Medical College, New York, NY (R.B.D.).
Circ Cardiovasc Imaging. 2015 Nov;8(11):e003644; discussion e003644. doi: 10.1161/CIRCIMAGING.115.003644.
The prognostic importance of left ventricular (LV) mass in nonsevere asymptomatic aortic stenosis has not been documented in a large prospective study.
Cox regression analysis was used to assess the impact of echocardiographic LV mass on rate of major cardiovascular events in 1656 patients (mean age, 67 years; 39.6% women) with mild-to-moderate asymptomatic aortic stenosis participating in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. Patients were followed during 4.3 years of randomized treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily or placebo. At baseline, LV mass index was 45.9+14.9 g/m(2.7), and peak aortic jet velocity was 3.09+0.54 m/s. During follow-up, 558 major cardiovascular events occurred. In Cox regression analyses, 1 SD (15 g/m(2.7)) higher baseline LV mass index predicted increases in hazards of 12% for major cardiovascular events, 28% for ischemic cardiovascular events, 34% for cardiovascular mortality, and 23% for combined total mortality and hospitalization for heart failure (all P<0.01), independent of confounders. In time-varying models, taking the progressive increase in LV mass index during follow-up into account, 1 SD higher in-study LV mass index was consistently associated with 13% to 61% higher hazard for cardiovascular events (all P<0.01), independent of age, sex, body mass index, valvuloarterial impedance, LV ejection fraction and concentricity, and the presence of concomitant hypertension.
Higher LV mass index is independently associated with increased cardiovascular morbidity and mortality during progression of aortic stenosis.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.
左心室（LV）质量在非重度无症状主动脉瓣狭窄中的预后重要性尚未在大型前瞻性研究中得到证实。
采用Cox回归分析评估1656例（平均年龄67岁；39.6%为女性）轻度至中度无症状主动脉瓣狭窄患者的超声心动图左心室质量对主要心血管事件发生率的影响，这些患者参与了主动脉瓣狭窄中辛伐他汀依折麦布（SEAS）研究。患者在4.3年的随机治疗期间接受每日40mg辛伐他汀与10mg依折麦布联合治疗或安慰剂治疗。基线时，左心室质量指数为45.9 + 14.9 g/m(2.7)，主动脉峰值射流速度为3.09 + 0.54 m/s。随访期间，发生了558例主要心血管事件。在Cox回归分析中，基线左心室质量指数每升高1个标准差（15 g/m(2.7)），主要心血管事件风险增加12%，缺血性心血管事件风险增加28%，心血管死亡率风险增加34%，全因死亡率和心力衰竭住院联合风险增加23%（所有P<0.01），且独立于混杂因素。在时变模型中，考虑到随访期间左心室质量指数的逐渐升高，研究期间左心室质量指数每升高1个标准差，心血管事件风险持续增加13%至61%（所有P<0.01），且独立于年龄、性别、体重指数、瓣膜动脉阻抗、左心室射血分数和同心性以及是否存在合并高血压。
较高的左心室质量指数与主动脉瓣狭窄进展过程中心血管发病率和死亡率增加独立相关。
