Patients with severe left ventricular (LV) dysfunction may or may not have overt heart failure and ventricular dysrhythmia. To study factors behind this variability, we examined a subset of 311 patients from the Studies of Left Ventricular Dysfunction-95 with a history of moderate heart failure (treatment trial) and 216 with no failure (prevention trial), all with ejection fractions <0.35. Echocardiographic variables were compared between trials and also correlated with dysrhythmia in 258 patients, and with neurohormones in 199 patients. Compared with prevention patients, treatment patients had larger LV end-diastolic diameter, end-systolic volume, sphericity index, and ratio of early to late diastolic filling velocity by Doppler (E/A ratio), lower LV ejection fraction and atrial contribution to ventricular filling, and similar LV mass, end-diastolic volume, and estimates of systolic wall stress. With prevention and treatment patients combined, the prevalence of abnormally elevated atrial natriuretic peptide was 92% in the highest tertile of E/A ratio compared with 55% in the lower tertiles (p = 0.006). Across tertiles of LV end-diastolic volume, there was an increase in the prevalence of nonsustained ventricular tachycardia (24%, 45%, and 45%; p = 0.007) and premature ventricular complexes > 10/hour (48%, 62%, and 80%; p <0.001). Thus, in severe LV dysfunction, ventricular filling indexes suggestive of high filling pressures, along with larger and more spherical ventricles, are particularly common in patients with overt heart failure, thus suggesting that diastolic properties and the degree of ventricular remodeling affect clinical status. Once ejection fraction is significantly reduced, the prevalence of ventricular dysrhythmia correlates with LV size rather than systolic function. This observation lends support to previous experimental findings on the role of myocardial stretch and scar in the genesis of dysrhythmia.
|Number of pages||6|
|Journal||American Journal of Cardiology|
|State||Published - Mar 15 1996|
Bibliographical noteFunding Information:
From the Divisions of Cardiolo y, Dalhousie Universi , Halifax, Nova Scotia, Canada; Baylor Co 9 leqe School of Me ! icine, Houston, Texas; Oregon Health Science; University, Portland, Oregon; Uni-versitv of Florida Colleae of Medicine, Gainesville, Florida; University of Texas Medical Schvool, Houston, Texas; Robert Wood Johnson School of Medicine, Piscataway, NewJersey; and the Collaborative Studies Coordinating Center, Department of Biostatistics, Chapel Hill, North Carolina. This study was supported by contracts from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda. Marvland. Manuscript receivedJulv6, 1995; revised manuscript received October 25, 1995, and bccepted October 26. Address for reorints: Chris Koiloillai. MD, Room 30.54.ACC. Dickson Centre, Vi&oria General H&pit&l, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 2Y9.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine