Related Experiment Video
Updated: Aug 7, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
U-Shaped Association Between Left Ventricular Dimension and Mortality in Patients With Heart Failure
Hua Wang1, Liwei Zhang1, Chen Ji1
1Department of Cardiology, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Insights
Both small and large left ventricles (LV) are linked to increased mortality risk in heart failure (HF) patients. This U-shaped association highlights the importance of LV size in predicting outcomes and guiding personalized HF management.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left ventricular (LV) structural assessment is crucial for heart failure (HF) management.
- The independent prognostic value of LV size, beyond ejection fraction, is not well-defined in large populations.
Purpose of the Study:
- To investigate the association between LV dimensions and mortality risk in a large, nationwide HF cohort.
- To determine if LV size independently predicts mortality in heart failure patients.
Main Methods:
- Nationwide cohort study using the Chinese Cardiovascular Association Database-Heart Failure Center Registry (2018-2022).
- Included 273,921 hospitalized HF patients categorized by LV end-diastolic diameter (LVEDD) using American Society of Echocardiography criteria.
- Analyzed all-cause and cardiovascular mortality, adjusting for relevant covariates.
Main Results:
- A significant U-shaped association was observed between LVEDD and both all-cause and cardiovascular mortality (P < .001).
- Both small (aHR, 1.32) and large (aHR, 1.38) LVs were independently associated with elevated all-cause mortality.
- Sex-specific optimal LVEDD thresholds were identified, with deviations increasing mortality risk.
Conclusions:
- A U-shaped association exists between LVEDD and mortality in HF patients.
- Both abnormally small and large LV dimensions are independent predictors of increased mortality risk.
- LV size assessment should be integrated into routine risk stratification for personalized HF management.
Importance:
Left ventricular structural assessment is fundamental in heart failure (HF). However, the independent prognostic value of left ventricular size beyond its association with ejection fraction remains poorly defined in real-world, large-scale populations.
Objective:
To investigate the association between left ventricular dimension and mortality risk within a large, nationwide cohort with HF.
Design, Setting, And Participants:
This was a nationwide cohort study using data from the Chinese Cardiovascular Association Database-Heart Failure Center Registry. Patients were enrolled from January 1, 2018, to May 31, 2022. The multicenter study involved 723 centers across 31 provincial-level administrative regions in mainland China. The study included patients hospitalized with HF. Patients were categorized into groups with a small, normal, or large left ventricle (LV) according to American Society of Echocardiography criteria for LV end-diastolic diameter (LVEDD). Data analysis was conducted from March to June 2025.
Exposure:
LVEDD measured by echocardiography.
Main Outcomes And Measures:
The primary and secondary end points were all-cause mortality and cardiovascular mortality, respectively.
Results:
A total of 273 921 patients (median [IQR] age, 71.0 [62.0-79.0] years; 161 589 male [59.0%]) hospitalized with HF were included in this study. A significant U-shaped association was found between LVEDD and both all-cause and cardiovascular mortality (P for nonlinearity <.001). Both a small LV (adjusted HR [aHR], 1.32; 95% CI, 1.28-1.37; P < .001) and a large LV (aHR, 1.38; 95% CI, 1.35-1.40; P < .001) were independently associated with elevated all-cause mortality. Sex-specific optimal LVEDD thresholds were identified (47 mm for male patients, 43 mm for female patients), with each 1-mm deviation associated with a significant increase in mortality risk. These findings were consistent across prespecified subgroups and were further corroborated by analysis of LVEDD indexed to body surface area and by extensive sensitivity analyses, including competing risk models and complete-case analyses.
Conclusions And Relevance:
This large-scale study established that a U-shaped association exists between LVEDD and mortality in HF, suggesting that both abnormally small and abnormally large ventricles signify high risk, likely through distinct mechanisms. These findings support the integration of LV size assessment into routine risk stratification to guide personalized management.
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:20Mitral Regurgitation I: Introduction
01:22Mitral Stenosis I: Introduction
01:17Pathophysiology of Heart Failure
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:26Heart Failure III: Clinical Manifestations