The prognostic legacy of left ventricular hypertrophy: cumulative evidence after the MAVI study

Objective: Although regression of left ventricular hypertrophy (LVH) confers a marked prognostic benefit, it is unknown whether cardiovascular risk in these patients is comparable to those who never developed LVH. Methods: We analyzed the 'Massa Ventricolare sinistra nell'Ipertensione' (MAVI) study, a prospective study in which serial changes in left ventricular mass at echocardiography were associated with subsequent cardiovascular events. We also conducted a cumulative meta-analysis in order to investigate how evidence progressed in this field. We defined three phenotypes: persistently normal left ventricular mass; LVH regression; persistence/new development of LVH. Results: Left ventricular mass was measured at baseline and 2 years after the initial assessment in 374 patients (64% women). Clinical outcomes were ascertained after the 2-year echocardiographic evaluation (mean follow-up 3.2 years). Persistence or new development of LVH was associated with an increased risk of cardiovascular events (odds ratio 1.96, 95% confidence interval 1.07-3.57, P0.029). In a cumulative meta-analyses that included MAVI and six comparable studies for a total of 2954 patients and 339 cardiovascular events, when a persistently normal left ventricular mass was taken as reference, regression of LVH was associated with 56% higher risk of cardiovascular events (odds ratio 1.56, 95% confidence interval 1.04-2.36, absolute risk increase 3%, P0.033). Conversely, evidence accrued from previous studies that persistence or new development of LVH predicts an adverse outcome did not change after MAVI. Conclusions: Cardiovascular risk is higher in patients with LVH regression than in those with persistently normal left ventricular mass. Preventing development of LVH is thus an important target.