Abstract 17192: Incidence and Prognostic Impact of Favorable Left Ventricular Remodeling after Cardiac Decompensation in Systolic Heart Failure
Background and aim: Left ventricular (LV) remodeling has been studied in great detail post myocardial infarction. Less clear is the potential of remodeling in patients with systolic heart failure (SHF) after an episode of acute cardiac decompensation
Methods: SHF patients hospitalized for decompensation were eligible if LV ejection fraction (EF) remained ≤40% before discharge. Echocardiography was performed before and 6 months after discharge. End-diastolic diameter (EDD) was measured in the parasternal long axis view. EF was quantified by Simpsons biplane method from apical 2- and 4-chamber views. Favorable LV remodeling (FR) was defined as any increase in EF plus any decrease in EDD. Survival status was assessed after 44 months (median).
Results: At baseline 846 patients were examined. After 6 months, 97/846 (11%) patients had died and in further 209/846 patients (25%), repeat echocardiography could not be performed. Hence, changes in LV size and function were examined in 540 patients; (mean patient age 65±12 years, 75% male). At baseline, mean EF and EDD were 29±7% and 62±9mm, respectively. FR was found in 239 patients (44%). In these, mean EF had increased from 29±7 to 45±10% and mean EDD had decreased from 64±8 to 56±8mm (p<0,001 both). In the remaining 301 patients, both, mean EF and EDD had increased (from 29±7 to 38±12% and from 60±9 to 64±8mm, respectively, p<0,001 both). In multivariate regression analysis, disease history <1 year, guideline adherent pharmacotherapy, absence of coronary artery disease (CAD) and absence of left branch bundle block (LBBB) were associated with FR. Assessment of survival revealed that 162/540 patients (30%) had died after the 2nd echocardiography. FR was associated with reduced risk of all-cause mortality (hazard ratio 0.51, 95% confidence interval 0.37-0.71, p<0,001); this was independent of potential confounders.
Conclusion: After an episode cardiac decompensation, improvement of EF was frequent, but only a concomitant reduction of EDD was associated with better long-term survival. In patients with long disease history, insufficient pharmacotherapy, presence of CAD or LBBB, FR was less frequent and closer follow-up might therefore be advisable.
- © 2012 by American Heart Association, Inc.