Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk

Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.

OBJECTIVES. We sought to determine whether growth influences the relation between left ventricular mass and body size and whether use of different body size indexes affects the ability of ventricular mass to predict complications of hypertension. BACKGROUND. Allometric (or growth) signals between left ventricular mass and height have recently been reported to improve previous approaches for normalization of ventricular mass for body size. METHODS. Residuals of left ventricular mass-height2.7 relations were analyzed in a learning series of 611 normotensive, normal-weight subjects 4 months to 70 years old and, separately, in 383 children (< 17 years old) and 228 adults. Ten-year cardiovascular morbidity in a test series of 253 hypertensive adults was compared with groups with normal or high baseline left ventricular mass normalized for body weight, height, body surface area and allometric powers of height. RESULTS. The dispersion of residuals of ventricular mass versus height2.7 increased with increasing height or age in children but not in adults, suggesting that the effect of other variables on ventricular growth increases during body growth and stabilizes in adulthood. Therefore, we derived separate allometric signals for adults (predicted ventricular mass = 45.4 x height2.13, r = 0.48) and children (32.3 x height2.3, r = 0.85) (both p < 0.0001). Patients with left ventricular hypertrophy had 3.3 times higher cardiac risk with elevated left ventricular mass/height2.7 (p < 0.001), 2.6 to 2.7 times higher risk with left ventricular mass indexed for height, height2.13 and body surface area (all p < 0.01) and 1.7 times the risk with ventricular mass/weight (p > 0.1). CONCLUSIONS. These results show the following: 1) Variability of left ventricular mass in relation to height increases during human growth; 2) allometric signals of left ventricular mass versus height are lower in adults and children than those obtained across the entire age spectrum; 3) height-based indexes of left ventricular mass at least maintain and may enhance prediction of cardiac risk by hypertensive left ventricular hypertrophy; and 4) the allometric signal derived across the entire spectrum of age appears to be more useful for prediction of cardiovascular risk than that computed in adults.

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				C. Zoccali, F. A. Benedetto, F. Mallamaci, G. Tripepi, G. Giacone, A. Cataliotti, G. Seminara, B. Stancanelli, and L. S. Malatino Prognostic Impact of the Indexation of Left Ventricular Mass in Patients Undergoing Dialysis J. Am. Soc. Nephrol., December 1, 2001; 12(12): 2768 - 2774. [Abstract] [Full Text] [PDF]

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				G. de Simone, F. Pasanisi, and F. Contaldo Link of Nonhemodynamic Factors to Hemodynamic Determinants of Left Ventricular Hypertrophy Hypertension, July 1, 2001; 38(1): 13 - 18. [Abstract] [Full Text] [PDF]

				R. Kuperstein, P. Hanly, M. Niroumand, and Z. Sasson The importance of age and obesity on the relation between diabetes and left ventricular mass J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1957 - 1962. [Abstract] [Full Text] [PDF]

				D. J. Slotwiner, R. B. Devereux, J. E. Schwartz, T. G. Pickering, G. de Simone, and M. J. Roman Relation of Age to Left Ventricular Function and Systemic Hemodynamics in Uncomplicated Mild Hypertension Hypertension, June 1, 2001; 37(6): 1404 - 1409. [Abstract] [Full Text] [PDF]

				T.-M. Lee, S.-F. Su, W.-Y. Suo, C.-Y. Lee, M.-F. Chen, Y.-T. Lee, and C.-H. Tsai Distension of urinary bladder induces exaggerated coronary constriction in smokers with early atherosclerosis Am J Physiol Heart Circ Physiol, December 1, 2000; 279(6): H2838 - H2845. [Abstract] [Full Text] [PDF]

				G.Y.H Lip, D.C Felmeden, F.L Li-Saw-Hee, and D.G Beevers Hypertensive heart disease. A complex syndrome or a hypertensive 'cardiomyopathy'? Eur. Heart J., October 2, 2000; 21(20): 1653 - 1665. [PDF]

				M. Kozakova, F. Galetta, L. Gregorini, G. Bigalli, F. Franzoni, C. Giusti, and C. Palombo Coronary Vasodilator Capacity and Epicardial Vessel Remodeling in Physiological and Hypertensive Hypertrophy Hypertension, September 1, 2000; 36(3): 343 - 349. [Abstract] [Full Text] [PDF]

				T.-M. Lee, S.-F. Su, M.-F. Chen, and C.-H. Tsai Acute effects of urinary bladder distention on the coronary circulation in patients with early atherosclerosis J. Am. Coll. Cardiol., August 1, 2000; 36(2): 453 - 460. [Abstract] [Full Text] [PDF]

				B. Kuch, H.-W. Hense, B. Gneiting, A. Doring, M. Muscholl, U. Brockel, and H. Schunkert Body Composition and Prevalence of Left Ventricular Hypertrophy Circulation, July 25, 2000; 102(4): 405 - 410. [Abstract] [Full Text] [PDF]

				K. F. Janz, J. D. Dawson, and L. T. Mahoney Predicting Heart Growth During Puberty: The Muscatine Study Pediatrics, May 1, 2000; 105(5): e63 - e63. [Abstract] [Full Text] [PDF]

				K. Wachtell, J. N. Bella, P. R. Liebson, E. Gerdts, B. Dahlof, T. Aalto, M. J. Roman, V. Papademetriou, H. Ibsen, J. Rokkedal, et al. Impact of Different Partition Values on Prevalences of Left Ventricular Hypertrophy and Concentric Geometry in a Large Hypertensive Population : The LIFE Study Hypertension, January 1, 2000; 35(1): 6 - 12. [Abstract] [Full Text] [PDF]

				G. Olivetti, E. Cigola, R. Maestri, C. Lagrasta, D. Corradi, and F. Quaini Recent advances in cardiac hypertrophy Cardiovasc Res, January 1, 2000; 45(1): 68 - 75. [Full Text] [PDF]

				V. Palmieri, G. de Simone, M. J. Roman, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Ambulatory Blood Pressure and M;etabolic Abnormalities in Hypertensive Subjects With Inappropriately High Left Ventricular Mass Hypertension, November 1, 1999; 34(5): 1032 - 1040. [Abstract] [Full Text] [PDF]

				J. E. Liu, M. J. Roman, R. Pini, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Cardiac and Arterial Target Organ Damage in Adults with Elevated Ambulatory and Normal Office Blood Pressure Ann Intern Med, October 19, 1999; 131(8): 564 - 572. [Abstract] [Full Text] [PDF]

				F. Perticone, R. Maio, R. Ceravolo, C. Cosco, C. Cloro, and P. L. Mattioli Relationship Between Left Ventricular Mass and Endothelium-Dependent Vasodilation in Never-Treated Hypertensive Patients Circulation, April 20, 1999; 99(15): 1991 - 1996. [Abstract] [Full Text] [PDF]

				J. N. Bella, R. B. Devereux, M. J. Roman, M. J. O'Grady, T. K. Welty, E. T. Lee, R. R. Fabsitz, B. V. Howard, and f. t. S. H. S. Investigators Relations of Left Ventricular Mass to Fat-Free and Adipose Body Mass : The Strong Heart Study Circulation, December 8, 1998; 98(23): 2538 - 2544. [Abstract] [Full Text] [PDF]

				H.-W. Hense, B. Gneiting, M. Muscholl, U. Broeckel, B. Kuch, A. Doering, G.u. A. J. Riegger, and H. Schunkert The associations of body size and body composition with left ventricular mass: impacts for indexation in adults J. Am. Coll. Cardiol., August 1, 1998; 32(2): 451 - 457. [Abstract] [Full Text] [PDF]

				S. S. Gidding Clinical and Epidemiological Significance of Left Ventricular Mass Assessed in Children and Adolescents Circulation, May 19, 1998; 97(19): 1893 - 1894. [Full Text] [PDF]