title: Adverse structural remodeling of the left ventricle and ventricular arrhythmias in patients with depressed ejection fraction.
abstract: BACKGROUND
  The relationship of life-threatening ventricular arrhythmias to specific patterns of adverse LV remodeling has not been reported. We examined the relationship of ventricular tachycardia and/or fibrillation (VT/VF) to the pattern of left ventricular (LV) structural remodeling and to the degree of LV dysfunction in patients with a low ejection fraction (EF).
  
  
  RESULTS
  Data from 127 patients with a low EF (≤0.45) and an implantable cardioverter-defibrillator (ICD) were examined and VT/VF identified by means of ICD device interrogation. Echocardiographic data were used to define LV structural remodeling (eccentric hypertrophy, concentric remodeling/hypertrophy, and normal geometry). VT/VF occurred in 26% of the 127 patients. VT/VF was more common in the 60 patients with LV hypertrophy versus the 67 with normal LV mass (40% vs 13%; P = .001) and in the 61 patients with LV enlargement versus the 66 with a normal chamber size (34% vs 18%; P = .04). When LV chamber size, wall mass, and geometry were assessed in a combinatorial fashion, a Kaplan-Meier analysis indicated that the occurrence of VT/VF was highest in the patients with eccentric hypertrophy (43%), intermediate in those with concentric remodeling/hypertrophy (30%), and lowest (12%) in those with normal geometry (all P < .02). The EFs were similar (P = ns) in these 3 groups of distinctly different patterns of remodeling.
  
  
  CONCLUSIONS
  Life-threatening ventricular arrhythmias in patients with a low EF are related to the pattern of LV remodeling, not the degree of LV dysfunction. Risk stratification of such patients might be improved by a consideration of the pattern of LV remodeling.
authors.affiliation: Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts. Electronic address: timothy.s.draper@lahey.org.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Draper
authors.affiliation: Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Silver
authors.affiliation: Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, and Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: William H
authors.initials: WH
authors.lastname: Gaasch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Hypertrophy; LV function; LV remodeling; ventricular tachycardia/fibrillation