Abstract
AimsStructural and functional left ventricular alterations can occur in heart failure (HF), referred to as left ventricular reverse remodelling (LVRR). This study aimed to define novel predictors of LVRR besides well‐known effects of medical and device therapy.Methods and resultsFrom echographic database, we included 295 patients with both left ventricular ejection fraction (LVEF) ≤45% and indexed left ventricular end‐diastolic diameter ≥33 mm/m2 and who had at least two echocardiographic exams with a delay between 3 and 12 months. LVRR was defined as the combination of (i) normalization of LVEF (LVEF ≥50%) or increase in LVEF ≥10% and (ii) a decrease in indexed left ventricular end‐diastolic diameter ≥10%. Clinical follow‐up was also obtained. LVRR occurred in 53 (18%) patients. Patients in the LVRR group were more likely to present with de novo HF (75% vs. 42%), had lower LVEF and left ventricular end‐diastolic volumes at index examination, yet a higher body mass index (BMI) than non‐LVRR patients. Obesity was observed in 25% of LVRR patients vs. 14% in others. In multivariate analyses, BMI (per each 1 kg/m2 increase) emerged as a predictor of LVRR: odds ratio 1.10 (95% confidence interval 1.02–1.19) after adjustment to other predictors of LVRR. During a mean follow‐up of 37 months, 32% of patients had a major adverse cardiac event; de novo HF, age, and LVEF were associated with major adverse cardiac event.ConclusionsWe identified significant relationship between high BMI and LVRR. This intriguing novel finding deserves further study.
Highlights
Heart failure (HF) is associated with structural and functional changes in the myocardium, referred to as ventricular remodelling
In contrast with Left ventricular remodelling (LVR), left ventricular reverse remodelling (LVRR) has been associated with improved survival
Among 295 included patients left ventricular ejection fraction (LVEF) increased by ≥0.10 in 72 and normalizes (LVEF ≥50%) in 25 patients while left ventricular end-diastolic diameter (LVEDDi) decreased by ≥10% in 55 patients
Summary
Heart failure (HF) is associated with structural and functional changes in the myocardium, referred to as ventricular remodelling. Left ventricular remodelling (LVR) further decreases ventricular performance and is strongly related to adverse outcome.. Left ventricular end-systolic volume and left ventricular end-diastolic volume have been proposed as the most reliable parameters of LVR, as these convey both structural and functional information, yet their respective critical to define LVR is debated.. Guideline-based therapies, both drugs and devices, can reverse the detrimental alterations to the left ventricle, referred to as left ventricular reverse remodelling (LVRR). In contrast with LVR, LVRR has been associated with improved survival.. We aimed to unravel new clinical predictors of LVRR and evaluate their impact on HF prognosis, by using a well-defined population of HF patients with regular clinical and echocardiographic follow-up
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