Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan heart failure trial (Val-HeFT) echocardiographic data.
OBJECTIVE
The objective of this study was to test the hypothesis that the severity of left ventricular remodeling predicts the response to treatment and outcomes in chronic heart failure.


BACKGROUND
Reversal of remodeling should produce the most favorable outcome in patients with the most severe remodeling.


METHODS
In 5010 heart failure patients on background therapy and randomized to valsartan and placebo, serial recordings of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) were read at sites that had to meet qualifying standards before participating. Baseline LVIDd and EF were pooled across treatments and retrospectively grouped by quartiles Q1 to Q4, representing best to worst. Kaplan-Meier survival curves were obtained by the log-rank test. Q1 was compared with Q4 for mortality and combined mortality and morbidity (M + M) from Cox regression risk ratios (RRs). Valsartan versus placebo changes from baseline in LVIDd and EF were analyzed by quartiles from analysis of covariance. Valsartan and placebo were compared by RRs for M + M.


RESULTS
Survival rates were greater in the better quartiles for LVIDd and EF (p < 0.00001). The RR for Q1 versus Q4 in events approached 0.5 for both LVIDd and EF (p < 0.0001). An LVIDd decrease and EF increase were quartile-dependent and greater with valsartan than placebo at virtually all time points. The RR for M + M outcomes favored valsartan in the worse quartiles.


CONCLUSIONS
Stratification by baseline severity of remodeling showed that patients with worse LVIDd and EF are at highest risk for an event, yet appear to gain the most anti-remodeling effect and clinical benefit with valsartan treatment.
Wong
Maylene
M
Veterans Affairs Greater Los Angeles Healthcare System, and David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California 90073, USA. maylene.wong@med.va.gov
Staszewsky
Lidia
L
Latini
Roberto
R
Barlera
Simona
S
Glazer
Robert
R
Aknay
Nora
N
Hester
Allen
A
Anand
Inder
I
Cohn
Jay N
JN
D000959:Antihypertensive Agents / Q000627:therapeutic use; D004452:Echocardiography; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013777:Tetrazoles / Q000627:therapeutic use; D014481:United States; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan; D020257:Ventricular Remodeling
D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D014633:Valine