Prognostic impact of different remodeling patterns in asymptomatic patients for heart failure

The universally-known description of LV remodeling is based on estimation of indexed LV mass (LVMi) and relative wall thickness (RWT). Recent papers improved this classification, with inclusion of indexed LV end-diastolic volume (EDVi) assessment, adding further categories, beside normal ventricle: Mixed Hypertrophy, Dilated and Physiological Hypertrophy. Purpose: To assess the prognostic impact of different remodeling patterns in a vast cohort of patients asymptomatic for Heart Failure Methods: In a sample of patients asymptomatic for HF, from a large multicenter survey, remodeling patterns were classified according to EDVi (cut-off 75 ml/m2), LVMi (cut-off 115 g/m2 for men; 95 g/m2 for women) and RWT (<0.32 for eccentric pattern, >0.42 for concentric one,0–32–0.42 for the others).Primary events at follow up included: cardiac death, pulmonary oedema, acute myocardial infarction, coronary revascularizations, stroke or transient ischemic attack. Results: In the total population (n=1729; Male 53.6%; BMI 26.2±5.6; Age 58.3±13 years) 14% were diabetic while 57% hypertensive. LVMi was 104.2±30.3 and RWT 0.4±0.1. In a multivariate analysis model dilated hypertrophy (OR 2.1; CI 95% 1.1–4.1; P=0.038) and eccentric hypertrophy (OR 2.9; CI 95% 1.3–6.2; p=0.007) were predictive for primary events. In particular, eccentric hypertrophy was independent predictive of acute pulmonary oedema (RR 9.6; CI 95% 3.4–27; p<0.001). Kaplan-Meier survival curves showed the worst prognosis for patients with concentric hypertrophy, dilated hypertrophy and eccentric remodeling. Cox- Regression analysis identified eccentric and concentric hypertrophy, as also systolic and diastolic dysfunction, as predictors of primary events.Conclusions: Better stratification of geometric patterns may allow a significant redefinition of therapeutic strategies, with potential prognostic benefit.