title: Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function.
abstract: BACKGROUND
  Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias.
  
  
  RESULTS
  Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009).
  
  
  CONCLUSIONS
  LV dilatation may complement ejection fraction to predict ventricular arrhythmias.
  
  
  BACKGROUND
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT02045043.
authors.affiliation: University of Colorado, Denver, CO (R.G.A., M.J.M., N.E.C., W.H.S.).
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Aleong
authors.affiliation: University of Colorado, Denver, CO (R.G.A., M.J.M., N.E.C., W.H.S.).
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mulvahill
authors.affiliation: University of Pittsburgh, PA (I.H., M.S., A.S., S.S.).
authors.forename: Indrani
authors.initials: I
authors.lastname: Halder
authors.affiliation: University of Colorado, Denver, CO (R.G.A., M.J.M., N.E.C., W.H.S.).
authors.forename: Nichole E
authors.initials: NE
authors.lastname: Carlson
authors.affiliation: University of Pittsburgh, PA (I.H., M.S., A.S., S.S.).
authors.forename: Madhurmeet
authors.initials: M
authors.lastname: Singh
authors.affiliation: Emory University and Atlanta VA Medical Center, Atlanta, GA (H.L.B.).
authors.forename: Heather L
authors.initials: HL
authors.lastname: Bloom
authors.affiliation: Lifespan Cardiovascular Institute and the Warren Alpert School of Medicine at Brown University, Providence, RI (S.C.D.).
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Dudley
authors.affiliation: Massachusetts General Hospital, Boston, MA (P.T.E.).
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.affiliation: University of Pittsburgh, PA (I.H., M.S., A.S., S.S.) Pittsburgh VA Healthcare System, Pittsburgh, PA (A.S.).
authors.forename: Alaa
authors.initials: A
authors.lastname: Shalaby
authors.affiliation: Ohio State University, Columbus, OH (R.W.).
authors.forename: Raul
authors.initials: R
authors.lastname: Weiss
authors.affiliation: University of Iowa, Iowa City, IA (R.G., B.L.).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gutmann
authors.affiliation: University of Colorado, Denver, CO (R.G.A., M.J.M., N.E.C., W.H.S.).
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.affiliation: Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (K.N., S.S.C.).
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (K.N., S.S.C.).
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
authors.affiliation: University of Pittsburgh, PA (I.H., M.S., A.S., S.S.).
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
authors.affiliation: University of Iowa, Iowa City, IA (R.G., B.L.).
authors.forename: Barry
authors.initials: B
authors.lastname: London
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004108:Dilatation, Pathologic; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
keywords: heart failure; ventricular arrhythmias