Rowe Stephanie J, Paratz Elizabeth D, Fahy Louise, Janssens Kristel, Spencer Luke W, D'Ambrosio Paolo, Strange Geoff, Prior David L, Playford David, Gerche Andre La
HEART Lab, St Vincent's Institute of Medical Research, Fitzroy, Australia.
Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
JACC Adv. 2024 Dec 13;4(1):101444. doi: 10.1016/j.jacadv.2024.101444. eCollection 2025 Jan.
In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear.
The goal of this study was to determine the relationship between small heart size and premature mortality within a large multicenter adult patient cohort with transthoracic echocardiographic examinations.
We divided 366,484 individuals with LVEF ≥50% (including a subset of 279,442 individuals with high-normal LVEF ≥60%) by sex and increasing quartiles for LV end-diastolic volume (LVEDV), LVEDV indexed to body surface area (LVEDVi), and LV end-diastolic diameter to assess associations with 5-year mortality through linkage with the National Death Index.
During approximately 2 million person-years of follow-up, 65,241 deaths occurred. Increasing LV chamber size was associated with reduced odds of 5-year all-cause mortality, particularly for higher LVEF. As compared with the larger quartiles, the smallest cardiac size quartiles were associated with higher 5-year all-cause mortality, even after adjusting for age. The smallest LVEDVi quartile was associated with a 14% to 18% higher odds of 5-year all-cause mortality, with a greater effect with high-normal LVEF. There was a U-shaped relationship between LV chamber size and all-cause mortality. For cardiovascular-related mortality, females in the smallest LVEDVi quartile had a 17% increased odds of mortality, which increased to 30% in those with LVEF ≥60%. In men, there was no significant association between smallest cardiac size and cardiovascular-related mortality.
In individuals with normal LVEF, small ventricular size is associated with increased mortality, particularly among females and those with higher LVEF.
在左心室射血分数（LVEF）保留的患者中，心室较小与功能能力下降有关，但其对临床结局的影响尚不清楚。
本研究的目的是在一个接受经胸超声心动图检查的大型多中心成年患者队列中，确定心脏较小与过早死亡之间的关系。
我们将366484例LVEF≥50%的个体（包括279442例LVEF≥60%的高正常LVEF亚组）按性别和左心室舒张末期容积（LVEDV）、体表面积指数化的LVEDV（LVEDVi）以及左心室舒张末期直径的四分位数增加进行分组，通过与国家死亡指数的关联来评估与5年死亡率的相关性。
在大约200万人年的随访期间，发生了65241例死亡。左心室腔大小增加与5年全因死亡率降低的几率相关，尤其是对于较高的LVEF。与较大的四分位数相比，即使在调整年龄后，最小的心脏大小四分位数与5年全因死亡率较高相关。最小的LVEDVi四分位数与5年全因死亡率高14%至18%的几率相关，在高正常LVEF时影响更大。左心室腔大小与全因死亡率之间存在U形关系。对于心血管相关死亡率，LVEDVi最小四分位数的女性死亡率几率增加17%，在LVEF≥60%的女性中增加到30%。在男性中，最小的心脏大小与心血管相关死亡率之间没有显著关联。
在LVEF正常的个体中，心室较小与死亡率增加相关，尤其是在女性和LVEF较高者中。
