Related Experiment Video
Updated: Apr 6, 2026
Biventricular Assessment of Cardiac Function and Pressure-Volume Loops by Closed-Chest Catheterization in Mice
Published on: June 15, 2020
Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function
Ryan G Aleong1, Matthew J Mulvahill1, Indrani Halder2
1University of Colorado, Denver, CO (R.G.A., M.J.M., N.E.C., W.H.S.).
Insights
Left ventricular (LV) dilatation and mass predict ventricular arrhythmias better than LV ejection fraction alone. Severe LV end-diastolic diameter and mass are associated with increased risk of implantable cardioverter-defibrillator shocks and adverse events.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Reduced left ventricular (LV) ejection fraction is a risk factor for ventricular arrhythmias, but its predictive sensitivity is low.
- LV dilatation and mass may offer improved risk stratification for ventricular arrhythmias.
Purpose of the Study:
- To evaluate the utility of LV diameter and mass in predicting ventricular arrhythmias and adverse outcomes in heart failure patients.
- To assess if LV dilatation and mass can enhance risk stratification beyond LV ejection fraction.
Main Methods:
- Analysis of 930 heart failure patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study.
- Assessment of appropriate implantable cardioverter-defibrillator shocks, and time to death, heart transplant, or ventricular assist device placement.
- Stratification of LV mass into normal, mild, moderate, and severe categories; analysis of LV end-diastolic diameter.
Main Results:
- Severe LV end-diastolic diameter was associated with significantly worse shock-free survival and freedom from death, transplant, or VAD placement compared to normal or mild categories.
- Severe LV mass was linked to worse shock-free survival but not significantly associated with death, transplant, or VAD placement.
- Multivariable analysis confirmed LV end-diastolic diameter as an independent predictor of appropriate ICD shocks (HR 1.22, P=0.020) and adverse events (HR 1.29, P=0.0009), adjusted for LV ejection fraction.
Conclusions:
- LV dilatation, specifically LV end-diastolic diameter, is a valuable predictor of ventricular arrhythmias and adverse outcomes in heart failure patients.
- LV dilatation may complement LV ejection fraction for more accurate risk stratification of ventricular arrhythmias.
- LV mass also showed prognostic value for shock-free survival, though less pronounced than LV diameter.
Background:
Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias.
Methods And Results:
Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009).
Conclusions:
LV dilatation may complement ejection fraction to predict ventricular arrhythmias.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT02045043.
Related Concept Videos
01:20Mitral Regurgitation I: Introduction
01:29Heart Failure II: Pathophysiology
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:22Mitral Stenosis I: Introduction
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:27Heart Failure I: Introduction