Unità Operativa Cardiologia Universitaria 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
Am Heart J. 2011 Jun;161(6):1088-95. doi: 10.1016/j.ahj.2011.03.027. Epub 2011 May 11.
Many descriptors of left ventricular (LV) remodeling have important prognostic implications in patients with chronic systolic heart failure (HF). We sought to assess the prognostic value of the combination of increased LV mass with a disproportion between wall thickness and internal diameter.
Patients (n = 536) with chronic HF, ejection fraction <50% and LV end-diastolic volume index >91 mL/m(2), classified according to LV mass index and relative wall thickness (RWT), were followed up for 33 ± 21 months. Ventricular mass was determined using a standard M-mode echocardiographic method. Relative wall thickness was defined as the ratio of (sum of interventricular septum thickness in diastole + posterior wall thickness in diastole)/LV end-diastolic diameter.
Prevalence of the pattern of increased LV mass index, defined as LV mass index >148 g/m(2) in men and >122 g/m(2) in women, and decreased RWT (<0.34) was 29%. Multivariable predictors of all-cause mortality were age >70 years (P < .0001), New York Heart Association class >2 (P < .0001), increased LV mass index, and decreased RWT (P = .003), E wave deceleration time ≤140 ms (P = .005), and male gender (P = .025). Patients with increased LV mass index and decreased RWT had a worse survival (33%) than patients with less LV mass index and normal to reduced RWT (log-rank 23.92; P < .0001). Comparisons of Cox models showed that the combination of increased mass index and decreased RWT added prognostic value to a model that included ejection fraction and end-systolic volume index.
In patients with systolic HF, an independent and incremental risk of adverse outcome was associated with increased mass index and decreased RWT.
许多左心室（LV）重构的描述在慢性收缩性心力衰竭（HF）患者中有重要的预后意义。我们试图评估LV 质量增加与壁厚与内径不成比例相结合的预后价值。
根据 LV 质量指数和相对壁厚（RWT）将 536 例慢性 HF、射血分数<50%和 LV 舒张末期容积指数>91 mL/m²的患者分为舒张末期内径，随访 33±21 个月。心室质量采用标准 M 型超声心动图方法确定。相对壁厚定义为（舒张期室间隔厚度+舒张期后壁厚度）/LV 舒张末期直径的比值。
LV 质量指数增加（男性>148 g/m²，女性>122 g/m²）和 RWT 降低（<0.34）的模式的患病率为 29%。全因死亡率的多变量预测因素为年龄>70 岁（P<0.0001）、纽约心脏协会（NYHA）分级>2 级（P<0.0001）、LV 质量指数增加和 RWT 降低（P=0.003）、E 波减速时间≤140 ms（P=0.005）和男性（P=0.025）。LV 质量指数增加和 RWT 降低的患者生存率较差（33%），低于 LV 质量指数较低且 RWT 正常或降低的患者（对数秩检验 23.92；P<0.0001）。Cox 模型比较显示，质量指数增加和 RWT 降低的组合为包括射血分数和收缩末期容积指数的模型增加了预后价值。
在收缩性 HF 患者中，质量指数增加和 RWT 降低与不良预后的独立和增量风险相关。
