0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.07.104 Inappropriate left ventricular mass independently predicts cardiovascular mortality in patients with type 2 diabetes ☆ Giovanni Cioffi a, ⁎, Andrea Rossi b , Giacomo Zoppini c , Giovanni Targher c , Giovanni de Simone d , Richard B. Devereux e , Corrado Vassanelli b , Enzo Bonora c a Department of Cardiology, Villa Bianca Hospital, Trento, Italy b Division of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona Italy c Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy d Department of Translational Medical Sciences, Federico II, University Hospital, School of Medicine, Naples, Italy e Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA article info Article history: Received 6 July 2013 Accepted 13 July 2013 Available online 5 August 2013 Keywords: Diabetes Inappropriate left ventricular mass Cardiovascular mortality Glomerular filtration rate Type 2 diabetes mellitus (T2DM) is associated with early maladap- tive cardiovascular (CV) phenotype, characterized by increased left ventricular (LV) mass (LVM), concentric geometry and subclinical LV dysfunction [1]. LVM is incongruously increased in approximately 30% of T2DM patients [2], a condition named “inappropriate” LVM (iLVM) [3]. The prognostic value of iLVM in these patients is unknown. We hypothesized that iLVM is an independent prognosticator of CV mortality among T2DM patients without overt cardiac disease. This research was conducted within the frame of the “Verona Diabetes Study” [4]. Among 937 initially eligible subjects who underwent a trans- thoracic echocardiogram during 1990–2007 for clinical reasons, 360 with T2DM without overt cardiac disease were selected. The study protocol was approved by local ethics committee and conforms to the ethical guidelines of the Declaration of Helsinki. Informed consent was acquired from each patient. Clinical history, physical, routine laboratory and echocardio- graphic evaluation were available in all participants. Glomerular filtration rate (GFR) was estimated by MDRD equation, chronic kidney disease (CKD) defined as GFR b 60 ml/min/1.73 m 2 . Echocardiograms followed the ASE guidelines, LVM calculated by Devereux's equation and normalized for height 2.7 . LVM ≥49.2 g/m 2.7 for men and ≥46.7 for women defined LV hypertrophy. Relative wall thickness indicated concentric LV geometry if ≥ 0.43. Mitral and aortic valve calcifications were recorded. Excess of LVM relative to the individual hemodynamic workload was assessed as the ratio between observed LVM and the value predicted from sex, individual stroke work (SW) and height [3] by the following validated equation: 55.37 + (6.64*height 2.7 ) + (0.64*SW) - (18.1*sex). SW was estimated as brachial systolic blood pressure (measured at the end of the echo exam) + CW Doppler trans-aortic peak gradient times stroke volume (by the Teichholtz's formula) and converted to gram-meters by multiplying by 0.014. Sex was assigned the value of 1 for men and 2 for women. Fig. 1. ROC curve analysis of independent risk factors (A); area under curve Table for ROC curve (B); Cut Point, Sensitivity and Specificity of independent risk factors (C). ☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. ⁎ Corresponding author at: Villa Bianca Hospital, via Piave 78, 38100 Trento, Italy. Tel.: +39 0461 916000; fax: +39 0461 916874. E-mail address: gcioffi@villabiancatrento.it (G. Cioffi). 4953 Letters to the Editor