Does left ventricular shape influence clinical outcome in heart failure?
BACKGROUND
Left ventricular (LV) shape tends to become spherical in patients with dilated cardiomyopathy of diverse etiology. Clinical and echocardiographic factors which affect the degree of LV spherical distortion and the impact of altered LV shape on prognosis have not been studied adequately.


OBJECTIVE
This study was undertaken to investigate the prognostic implications of altered LV shape on clinical outcome in dilated cardiomyopathy.


METHODS
In 112 patients with depressed LV ejection fraction (19 +/- 9%) and symptomatic heart failure, and in 10 age- and gender-matched normal controls, we performed 2-dimensional echocardiography to assess LV shape using the eccentricity index. Eccentricity index was defined as the ratio of the LV long axis to the LV transverse diameter, measured at end systole and end diastole in the apical four-chamber view. We sought univariate and multivariate clinical and echocardiographic correlates of LV shape. Further, we sought correlations between eccentricity index and clinical outcomes (death and composite outcome of death or emergent heart transplant).


RESULTS
Compared with controls, patients with cardiomyopathy had significantly lower systolic (2.04 vs. 1.56; p = 0.001) and diastolic (1.75 vs. 1.53; p = 0.003) eccentricity index, implying a more spherical LV shape. Of all clinical and echocardiographic variables tested, mitral regurgitation, right ventricular dysfunction, and increased LV mass were independently associated with spherical LV shape. At a follow-up period of 17 +/- 12 months, no correlation was found between eccentricity index and the occurrence of death or the combined endpoint of death or emergent heart transplant, in univariate or multivariate analysis.


CONCLUSIONS
In patients with dilated cardiomyopathy, the degree of spherical distortion of the LV does not correlate with prognosis.
Harjai
K J
KJ
Department of Cardiology, Ochsner Clinic, New Orleans, Louisiana 70345, USA.
Edupuganti
R
R
Nunez
E
E
Turgut
T
T
Scott
L
L
Pandian
N G
NG
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D003627:Data Interpretation, Statistical; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging; D011379:Prognosis; D011897:Random Allocation; D013599:Systole; D013997:Time Factors; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000000981:diagnostic imaging