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

Abstract

ABSTRACT Background 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. Methods 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. Results 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). Conclusions Small adverse changes in linear dimensions of LVESD and LVEDD are clinically significant in patients with HF.