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Purpose: Our aim was to assess the association of left ventricular mass with all-cause mortality and nonfatal cardiovascular events in a large cohort of patients referred for echocardiography.Methods: Left ventricular mass was measured in 40138 patients ≥18 years of age (mean age 61.1±16.4 years, 52.5% male) who underwent a first transthoracic echocardiogram at our institution between January 1994 and March 2008. The endpoints were all-cause mortality, nonfatal myocardial infarction and nonfatal ischemic and hemorrhagic stroke.Results: The proportion of patients with normal, mildly, moderately and severely increased left ventricular mass according to the American Society of Echocardiography criteria was 52.4%, 16.0%, 10.9% and 20.7%, respectively. During a mean follow-up period of 5.6 ± 3.9 years, 9181 patients died, 901 patients had a nonfatal myocardial infarction, and 2139 patients had a nonfatal stroke (including 1808 ischemic strokes and 400 hemorrhagic strokes). Cumulative 10-year survival was 73.6%, 68.6%, 63.5% and 54.6% in patients with normal, mildly, moderately and severely increased left ventricular mass, respectively (p<0.001). After adjustment in multivariable Cox proportional hazard analysis, left ventricular mass remained an independent predictor of all-cause mortality (hazard ratio [HR] per 100 g increment in left ventricular mass 1.21, 95% confidence interval [CI] 1.14-1-27, p<0.001 in women, and HR 1.09, 95% CI 1.04-1-13, p<0.001 in men), nonfatal myocardial infarction (HR 1.60, 95% CI 1.31-1.94, p<0.001 in women and HR 1.15, 95% CI 1.02-1.29, p=0.019 in men), ischemic stroke (HR 1.24, 95% CI 1.10-1.39, p<0.001 in women and HR 1.18, 95% CI 1.07-1.30, p<0.001 in men), hemorrhagic stroke (HR 1.26, 95% CI 0.97-1.65, p=0.09 in women and HR 1.23, 95% CI 1.02-1.48, p=0.03 in men), and total stroke (HR 1.26, 95% CI 1.13-1.40, p<0.001 in women and HR 1.19, 95% CI 1.09-1.30, p<0.001 in men).Conclusion: Left ventricular mass has a graded and independent association with all-cause mortality, myocardial infarction and stroke.