Patterns of left ventricular remodeling in chronic heart failure: prevalence and prognostic implications
Frank Lloyd Dini1, Paola Capozza, Francesca Donati
1Unità Operativa Cardiologia Universitaria 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy. f.dini@ao-pisa.toscana.it
Insights
In patients with systolic heart failure (HF), increased left ventricular (LV) mass and decreased relative wall thickness (RWT) independently predict a worse prognosis. This combination identifies a high-risk group needing closer monitoring for adverse outcomes.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left ventricular (LV) remodeling is crucial in chronic systolic heart failure (HF).
- Specific LV mass and geometry patterns may offer prognostic insights.
- Assessing LV mass index and relative wall thickness (RWT) combination is key.
Purpose of the Study:
- To evaluate the prognostic significance of combined increased LV mass and disproportionate LV geometry in systolic HF.
- To determine if this specific remodeling pattern predicts adverse outcomes.
- To assess the incremental prognostic value beyond traditional HF markers.
Main Methods:
- 536 patients with chronic systolic HF (ejection fraction <50%) were analyzed.
- LV mass index and RWT were calculated using echocardiography.
- Patients were followed for 33 months to assess all-cause mortality.
Main Results:
- 29% of patients exhibited increased LV mass index and decreased RWT.
- This pattern was an independent predictor of mortality, alongside age, NYHA class, and E wave deceleration time.
- Patients with increased LV mass index and decreased RWT had significantly worse survival.
Conclusions:
- Increased LV mass index and decreased RWT represent an independent risk factor in systolic HF.
- This echocardiographic pattern provides incremental prognostic value.
- Identifying this specific LV remodeling pattern aids in risk stratification for heart failure patients.
Background And Aim:
Many descriptors of left ventricular (LV) remodeling have important prognostic implications in patients with chronic systolic heart failure (HF). We sought to assess the prognostic value of the combination of increased LV mass with a disproportion between wall thickness and internal diameter.
Methods And Patients:
Patients (n = 536) with chronic HF, ejection fraction <50% and LV end-diastolic volume index >91 mL/m(2), classified according to LV mass index and relative wall thickness (RWT), were followed up for 33 ± 21 months. Ventricular mass was determined using a standard M-mode echocardiographic method. Relative wall thickness was defined as the ratio of (sum of interventricular septum thickness in diastole + posterior wall thickness in diastole)/LV end-diastolic diameter.
Results:
Prevalence of the pattern of increased LV mass index, defined as LV mass index >148 g/m(2) in men and >122 g/m(2) in women, and decreased RWT (<0.34) was 29%. Multivariable predictors of all-cause mortality were age >70 years (P < .0001), New York Heart Association class >2 (P < .0001), increased LV mass index, and decreased RWT (P = .003), E wave deceleration time ≤140 ms (P = .005), and male gender (P = .025). Patients with increased LV mass index and decreased RWT had a worse survival (33%) than patients with less LV mass index and normal to reduced RWT (log-rank 23.92; P < .0001). Comparisons of Cox models showed that the combination of increased mass index and decreased RWT added prognostic value to a model that included ejection fraction and end-systolic volume index.
Conclusion:
In patients with systolic HF, an independent and incremental risk of adverse outcome was associated with increased mass index and decreased RWT.
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