Prognostic Significance and Factors Associated With Worsening LV Dilatation in Heart Failure

Left-ventricular end-systolic dimension (LVESD) and end-diastolic dimension (LVEDD) are associated with adverse outcomes in heart failure (HF). The prognostic significance of a change in LVESD or LVEDD is uncertain.

This retrospective cohort study included patients experiencing ≥ 1 HF hospitalization or emergency department (ED) visit between April 2008 and March 2016 and underwent ≥ 2 echocardiograms, separated by ≥ 6 months. The primary outcome was the composite all-cause mortality, HF hospitalization, and ED visits for HF. We performed cut-point analysis to determine the threshold increase in LVESD or LVEDD associated with all-cause mortality. We evaluated characteristics associated with an increase in LVESD and LVEDD above threshold using multivariable logistic regression.

We included 8790 patients, 56.1% were male, with a mean (SD) age of 70.9 (14.5). The thresholds for change in LVESD and LVEDD associated with all-cause mortality were -3.13% and 1.33%, respectively. Patients with ischemic cardiomyopathy and lower LVEF were at increased risk of a change in LV size above the threshold. There was a significant association between an increase in LVESD or LVEDD above threshold and the composite outcome (HR 1.13; 95% CI 1.06, 1.20; HR 1.07; 95% CI 1.01, 1.13, respectively). An increase in LVESD or LVEDD above threshold was associated with increased risk of HF hospitalization (HR 1.27; 95% CI 1.15, 1.39; HR 1.24; 95% CI 1.12, 1.36) and an increased risk of ED visits for HF (HR 1.25; 95% CI 1.15, 1.37; HR 1.16; 95% CI 1.06, 1.26).

Small adverse changes in linear dimensions of LVESD and LVEDD are clinically significant in patients with HF.