title: Classification and Prognostic Evaluation of Left Ventricular Remodeling in Patients With Asymptomatic Heart Failure.
abstract: Patients with asymptomatic heart failure (HF; stage A and B) are characterized by maladaptive left ventricular (LV) remodeling. Classic 4-group classification of remodeling considers only LV mass index and relative wall thickness as variables. Complex remodeling classification (CRC) includes also LV end-diastolic volume index. Main aim was to assess the prognostic impact of CRC in stage A and B HF. A total of 1,750 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. LV dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow velocity pattern), was evaluated, together with LV remodeling. We considered a composite end point: all-cause death, myocardial infarction, coronary revascularizations, cerebrovascular events, and acute pulmonary edema. CRC was suitable for 1,729 patients (men 53.6%; age 58.3 ± 13 years). Two hundred thirty-eight patients presented systolic dysfunction (ejection fraction <50%) and 483 diastolic dysfunction. According to the CRC, 891 patients were normals or presented with physiologic hypertrophy, 273 concentric remodeling, 47 eccentric remodeling, 350 concentric hypertrophy, 29 mixed hypertrophy, 86 dilated hypertrophy, and 53 eccentric hypertrophy. Age and gender distribution was noticed (p <0.001). After a median follow-up of 21 months, Kaplan-Meier analysis showed different survival distribution (p <0.001) of the CRC patterns. In multivariate Cox regression (adjusted for age, gender, history of stable ischemic heart disease, classic remodeling classification, systolic, and diastolic dysfunction), CRC was independent predictor of primary end point (p = 0.044, hazard ratio 1.101, 95% CI 1.003 to 1.21), confirmed in a logistic regression (p <0.03). In conclusion, CRC could help physicians in prognostic stratification of patients in stage A and B HF.
authors: Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Italy. Electronic address: n.r.pugliese88@gmail.com.
authors: Nicola Riccardo
authors: NR
authors: Pugliese
authors: Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Italy.
authors: Iacopo
authors: I
authors: Fabiani
authors: Ospedale Villa Sofia, Dipartimento di Cardiologia, Palermo, Italy.
authors: Salvatore
authors: S
authors: La Carrubba
authors: Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Italy.
authors: Lorenzo
authors: L
authors: Conte
authors: Ospedale Santa Maria degli Angeli-Dipartimento di Patologia Cardiovascolare ed Aterosclerosi.
authors: Francesco
authors: F
authors: Antonini-Canterin
authors: Azienda Ospedaliero Universitaria Policlinico, Dipartimento di Cardiologia - Bari U.O.C. Cardiologia Ospedaliera.
authors: Paolo
authors: P
authors: Colonna
authors: Azienda Ospedaliera Monaldi, Dipartimento di Caridologia, Napoli, Italy.
authors: Pio
authors: P
authors: Caso
authors: UOC Cardiologia Clinica e Riabilitativa Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Dipartimento di Cardiologia, Reggio Calabria, Italy.
authors: Frank
authors: F
authors: Benedetto
authors: Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Italy.
authors: Veronica
authors: V
authors: Santini
authors: Azienda Ospedaliera Universitaria "San Giovanni di Dio e Ruggiero d'Aragona", Salerno, Italy.
authors: Scipione
authors: S
authors: Carerj
authors: Scuola Superiore S.Anna, Dipartimento di Statistica, Pisa, Italy.
authors: Maria Francesca
authors: MF
authors: Romano
authors: Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, Italy.
authors: Rodolfo
authors: R
authors: Citro
authors: Dipartimento di Patologia Medica, Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Italy.
authors: Vitantonio
authors: V
authors: Di Bello
mesh_terms: D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D020257:Ventricular Remodeling / Q000502:physiology*