title: Patterns of left ventricular remodeling in chronic heart failure: prevalence and prognostic implications.
abstract: OBJECTIVE
  Many descriptors of left ventricular (LV) remodeling have important prognostic implications in patients with chronic systolic heart failure (HF). We sought to assess the prognostic value of the combination of increased LV mass with a disproportion between wall thickness and internal diameter.
  
  
  METHODS
  Patients (n = 536) with chronic HF, ejection fraction <50% and LV end-diastolic volume index >91 mL/m(2), classified according to LV mass index and relative wall thickness (RWT), were followed up for 33 ± 21 months. Ventricular mass was determined using a standard M-mode echocardiographic method. Relative wall thickness was defined as the ratio of (sum of interventricular septum thickness in diastole + posterior wall thickness in diastole)/LV end-diastolic diameter.
  
  
  RESULTS
  Prevalence of the pattern of increased LV mass index, defined as LV mass index >148 g/m(2) in men and >122 g/m(2) in women, and decreased RWT (<0.34) was 29%. Multivariable predictors of all-cause mortality were age >70 years (P < .0001), New York Heart Association class >2 (P < .0001), increased LV mass index, and decreased RWT (P = .003), E wave deceleration time ≤140 ms (P = .005), and male gender (P = .025). Patients with increased LV mass index and decreased RWT had a worse survival (33%) than patients with less LV mass index and normal to reduced RWT (log-rank 23.92; P < .0001). Comparisons of Cox models showed that the combination of increased mass index and decreased RWT added prognostic value to a model that included ejection fraction and end-systolic volume index.
  
  
  CONCLUSIONS
  In patients with systolic HF, an independent and incremental risk of adverse outcome was associated with increased mass index and decreased RWT.
authors.affiliation: Unità Operativa Cardiologia Universitaria 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy. f.dini@ao-pisa.toscana.it
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.forename: Paola
authors.initials: P
authors.lastname: Capozza
authors.forename: Francesca
authors.initials: F
authors.lastname: Donati
authors.forename: Anca
authors.initials: A
authors.lastname: Simioniuc
authors.forename: Anca Irina
authors.initials: AI
authors.lastname: Corciu
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Andrea
authors.initials: A
authors.lastname: Pieroni
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D013318:Stroke Volume; D020257:Ventricular Remodeling / Q000502:physiology