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Updated: May 23, 2026
A Rat Model of Pressure Overload Induced Moderate Remodeling and Systolic Dysfunction as Opposed to Overt Systolic Heart Failure
Published on: April 30, 2020
Left ventricular remodeling in human heart failure: quantitative echocardiographic assessment of 1,794 patients
Bonnie Ky1, Ted Plappert, James Kirkpatrick
1Division of Cardiovascular Medicine Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. bonnie.ky@uphs.upenn.edu
Insights
In heart failure (HF), the left ventricle (LV) remodels to maintain stroke volume (SV) across a wide ejection fraction (EF) range. However, LV architecture cannot compensate for reduced EF below 20%.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left ventricular (LV) remodeling is a hallmark of heart failure (HF).
- The relationship between cardiac function and LV size/performance in HF is not fully understood.
- This study analyzes adaptive remodeling in chronic human HF using quantitative echocardiography.
Purpose of the Study:
- To define adaptive remodeling in chronic human heart failure.
- To investigate the associations between cardiac function and LV size/performance.
- To analyze a large quantitative echocardiography database for insights into HF remodeling.
Main Methods:
- Echocardiograms from 1,794 HF patients with diverse ejection fractions (EF) were analyzed.
- Core lab measurements included LV volumes and length to derive EF, mass, sphericity, stroke volume (SV), and stroke work.
- Spearman correlation and linear regression identified relationships between remodeling parameters.
Main Results:
- Indexed end-systolic volumes strongly correlated with EF (R=-0.87, P<0.0001).
- Systolic sphericity index and LV mass also showed significant correlations with EF (R=-0.62, R=-0.63, P<0.0001).
- Stroke volume (SV) was maintained until EF dropped below 20%, after which it significantly decreased.
Conclusions:
- The left ventricle (LV) undergoes extensive structural remodeling in chronic heart failure (HF).
- This adaptive remodeling aims to maintain stroke volume (SV) across a wide range of ejection fractions (EF).
- Below 20% EF, ventricular architecture alterations can no longer effectively modulate SV.
Background:
The left ventricle (LV) undergoes significant architectural remodeling in heart failure (HF). However, the fundamental associations between cardiac function and LV size and performance have not been thoroughly characterized in this population. We sought to define the adaptive remodeling that occurs in chronic human HF through the detailed analyses of a large quantitative echocardiography database.
Methods:
Baseline echocardiograms were performed in 1,794 patients with HF across a broad range of ejection fraction (EF), from less than 10% to greater than 70%. Core lab measurements of LV volumes and length were made, from which EF, mass, sphericity indices, stroke volume (SV), and stroke work were derived. Spearman correlation coefficients and linear regression methods were used to determine the relationships between remodeling parameters.
Results:
The median EF was 28.6% (IQR 21.9-37.0). Across a multitude of parameters of cardiac structure and function, indexed end-systolic volumes (ESVs) explained the greatest proportion of the variance in EF (R =-0.87, P < 0.0001). Systolic sphericity index and LV mass were also strongly correlated with EF (R =-0.62 and -0.63, P < 0.0001), reflective of the alterations in LV shape and size that occur as EF declines. SV was rigorously maintained across a broad spectrum of EF, until the EF fell below 20%, at which point SV decreased significantly (P < 0.0001).
Conclusions:
In chronic HF, the LV undergoes extensive structural adaptive remodeling in order to maintain SV across a broad range of EF. However, when the EF falls below 20%, further modulation of SV is no longer possible through alterations in ventricular architecture.
