Left Ventricular Hypertrophy and Mortality Risk in Male Veteran Patients at High Cardiovascular Risk

Several studies addressed cardiovascular risk and mortality in the general population, but data in veteran patients is lacking. This study was designed to investigate the association between echocardiographic left ventricular hypertrophy (LVH) and all-cause mortality in a male, high-risk group of veterans. Valid echocardiograms were evaluated in 10,406 male veterans, mean age 68.3 ± 13 years. Using the left ventricular mass/body surface area (LVM/BSA) method 6,575 (63.1%) patients had normal left LVMI and 3,831 (37.9%) had LVH, defined as LVMI ≥116 g/m². Of those 1,371 (13.2%) had mild LVH, 1,025 (9.9%) moderate LVH, 605 (5.8%) severe, and 830 (8%) had extreme LVH. After a mean follow up of 5.9 ± 4.4 years, a total of 3,550 (34.1%) patients died. Cox proportional hazard analyses adjusted for co-morbidities revealed increased risk for individuals with mild LVH (hazard ratios [HR] 1.21; 95% confidence intervals [CI]: 1.09 to 1.33); moderate LVH (HR 1.37; 95% CI: 1.23 to 1.52); severe (HR = 1.36; 95% CI: 1.19 to 1.56); and extreme LVH, (HR = 1.95; 95% CI: 1.74 to 2.17). Similar findings were observed when LVMI was defined by LVM/m^2.7. When LVM index was introduced as a continuous variable, mortality risk was 6.2% higher per 10-unit change in LVMI, and 9.4% higher when defined by the m^2.7 method. There was no difference in mortality risk between black and white patients, or patients with concentric or eccentric LVH. We conclude that increased LVMI was associated with increased risk of all-cause mortality. The incremental risk was significantly higher in patients with extreme LVH.