Case Western Reserve University, Cleveland, OH, USA.
Am J Cardiol. 2012 Jul 1;110(1):83-7. doi: 10.1016/j.amjcard.2012.02.054. Epub 2012 May 1.
In many patients with left ventricular (LV) systolic dysfunction, the LV ejection fraction (LVEF)-a surrogate for reverse remodeling-fails to improve despite optimal medical therapy. The early identification of such patients would allow instituting aggressive treatment, including early therapy with implantable cardioverter defibrillators. We sought to establish the predictors of reverse remodeling in patients with LV systolic dysfunction receiving optimal medical therapy. Patients (n = 568) with newly documented LVEF of ≤0.35, who had ≥1 follow-up echocardiogram after ≥3 months, were evaluated. Reverse remodeling was defined as improvement in LVEF to >0.35. The clinical, laboratory, and echocardiographic data were compared between patients with (n = 263) and without (n = 305) reverse remodeling. The mean follow-up was 27 ± 16 months. Patients who demonstrated reverse remodeling had a significantly greater mean follow-up LVEF (0.51 ± 0.09 vs 0.25 ± 0.08; p <0.001). On multivariate analysis, the baseline LV end-systolic diameter index was the strongest predictor of reverse remodeling (odds ratio 5.79; 95% confidence interval 1.82 to 18.46; p <0.001). Other independent predictors of reverse remodeling were female gender (odds ratio 1.88; 95% confidence interval 1.19 to 2.98; p = 0.007), and nonischemic cardiomyopathy (odds ratio 1.65; 95% confidence interval 1.05 to 2.58; p = 0.03). Baseline LVEF was not an independent predictor of reverse remodeling. In conclusion, among patients with newly diagnosed LV systolic dysfunction, the LV end-systolic diameter index, but not the LVEF, at diagnosis, was a strong predictor of reverse remodeling. Patients with a low likelihood of reverse remodeling might benefit from more aggressive heart failure therapy, including the possible early use of implantable cardioverter defibrillators.
在许多左心室（LV）收缩功能障碍患者中，尽管接受了最佳药物治疗，但 LV 射血分数（LVEF）——作为逆向重构的替代指标——仍未能改善。早期识别此类患者将有助于采取积极的治疗措施，包括早期使用植入式心脏复律除颤器。我们旨在确定接受最佳药物治疗的 LV 收缩功能障碍患者逆向重构的预测因素。评估了 568 名新确诊 LVEF≤0.35 的患者，这些患者在≥3 个月后至少有 1 次随访超声心动图。将 LVEF 改善>0.35 定义为逆向重构。比较了有（n=263）和无（n=305）逆向重构的患者之间的临床、实验室和超声心动图数据。平均随访时间为 27±16 个月。显示逆向重构的患者平均随访 LVEF 显著更高（0.51±0.09 比 0.25±0.08；p<0.001）。多变量分析显示，基线 LV 收缩末期内径指数是逆向重构的最强预测因素（比值比 5.79；95%置信区间 1.82 至 18.46；p<0.001）。逆向重构的其他独立预测因素是女性（比值比 1.88；95%置信区间 1.19 至 2.98；p=0.007）和非缺血性心肌病（比值比 1.65；95%置信区间 1.05 至 2.58；p=0.03）。基线 LVEF 不是逆向重构的独立预测因素。结论：在新诊断为 LV 收缩功能障碍的患者中，LV 收缩末期内径指数，而不是诊断时的 LVEF，是逆向重构的强有力预测因素。逆向重构可能性低的患者可能受益于更积极的心力衰竭治疗，包括可能早期使用植入式心脏复律除颤器。
