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Experimental Biology 2010: Relationship Between Left Ventricular Mass And Aortic Valve Calcification: The Multi-Ethnic Study Of Atherosclerosis
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Relationship Between Left Ventricular Mass And Aortic Valve Calcification: The Multi-Ethnic Study Of Atherosclerosis
S. Elmariah1, K.D O'Brien2, M.J. Budoff3, D. Bluemke4,5, J.A. Delaney2 ,V. Fuster1, R.A. Kronmal2,J.L. Halperin1 1Cardiovascular Institute, The Mount Sinai School of Medicine, New York, NY 2 University of Washington, Seattle, WA 3 Harbour-UCLA Medical Center, Torrance, CA 4 Johns Hopkins University School of Medicine, Baltimore, MD 5 National Institutes of Health, Bethesda, MD 6 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
Purpose of Study: Aortic valve calcification (AVC) occurs during the early stages of valve remodeling, frequently before the development of hemodynamic valve obstruction. Data suggest that left ventricular hypertrophy, widely considered a compensatory consequence of aortic stenosis (AS), may be associated with calcific aortic valve disease (CAVD) in the absence of AS. Methods Used: 5,042 subjects aged 45-84 years underwent cardiac magnetic resonance imaging and computed tomography (CT) within the Multi-Ethnic Study of Atherosclerosis (MESA). The relationship of baseline percent of predicted left ventricular mass (LVM; standardized for gender, height, and weight) to the prevalence, severity, and incidence of AVC was determined by regression modeling. Summary of Results: AVC was prevalent in 631 subjects at baseline. An additional 227 subjects developed incident AVC at follow-up (median 3.1 years later). After adjustment for age, gender, body mass index, demographics, study site, antihypertensive therapy, statin use, diabetes, smoking status, blood pressure, and cholesterol levels, LVM was positively associated with AVC prevalence (prevalence ratio=1.06 [95%CI 1.03, 1.10]; p<0.0005; all results reported per 10% increase) and severity (risk difference = 1.15 [95%CI 1.09, 1.22]; p<0.0001) at baseline. In those without AVC at baseline, LVM was associated with the development of AVC (relative risk=1.17 [95%CI 1.05, 1.31]; p<0.005). Conclusions: In the diverse MESA cohort, LVM was associated with prevalence and severity of AVC. An association between baseline LVM and incident AVC suggests that increased left ventricular mass may precede CAVD. Further study is needed to determine the mechanisms responsible for this association and evaluate its impact on patient outcomes.
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