Abstract 12123: Relationship between Arterial Impedance and Concentric Remodeling in Patients with Normal Systolic Function: Impact on Prevalence and Survival
Background: Cardiac remodeling, including concentric remodeling (CR), develops in response to abnormal hemodynamics. Although CR is associated with increased morbidity and mortality, little is known about the interaction of arterial impedance (IMP) on survival in CR.
Methods: We evaluated 50,421 patients with normal systolic function to assess prevalence of CR and the impact of CR and IMP on survival during a follow-up of 3.9 ± 2.3 years. In a cohort of 2,636 patients with paired echocardiograms, we assessed the impact of IMP on mortality, based on maintaining a high or low IMP (above or below 4.0 mmHg/ml/m2) over a follow-up of 3.0 ± 2.0 years.
Results: CR occurred in 21% and was associated with twice the mortality compared to subjects with normal LV structure (7.7% versus 3.2%; p<0.0001). The prevalence of CR increased with increasing IMP (p <0.001 for trend). In the paired-echo cohort, CR patients with an IMP < 4.0 had a mortality of 6.3%, with 58% converting to a normal LV structure whereas mortality was higher (10%; p<0.0001) and conversion to a normal LV structure was less frequent (46%; p<0.001) in CR patients whose IMP remained ≥ 4.0. (Figures 1 and 2)
Conclusions: (1) CR is prevalent and is associated with high mortality; (2) The prevalence of CR increases with higher IMP; (3) Once CR is manifest, IMP < 4.0 mmHg/ml/m2 is associated with a lower mortality and greater conversion to a normal LV structure over time (4) Further studies are needed to determine the clinical impact of reporting and targeting IMP in CR.
- © 2011 by American Heart Association, Inc.