Reverse remodelling criteria to predict cardiovascular death in heart failure with reduced or mid-range ejection fraction. (14th October 2021)

• Record Type: Journal Article
• Authors: Aimo, A; Fabiani, I; Vergaro, G; Arzilli, C; Chubuchny, V; Pasanisi, E.M; Petersen, C; Poggianti, E; Taddei, C; Bayes-Genis, A; Lupon, J; Giannoni, A; Georgiopoulos, G; Passino, C; Emdin, M
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Ventricular Remodelling; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0772
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Reverse remodelling (RR) is the recovery from left ventricle (LV) dilatation and dysfunction. There are no established definitions of RR. We sought to identify RR criteria that better predicted cardiovascular death. Methods and results: Forty-two studies used 25 criteria to define RR, most commonly (n=12) as LV end-systolic volume (LVESV) reduction ≥15%. We evaluated 927 patients with LV ejection fraction (LVEF) <50% undergoing 2 echocardiograms within 12±2 months. Over a median 2.8-year follow-up after the second echocardiogram (1.3–4.9), 123 cardiovascular deaths occurred (13%). Model 1 included age, LVEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP), ischaemic aetiology, cardiac resynchronization therapy (CRT), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA), and LVESV index (LVESVi), and Model 2 the validated 3C-HF score. Two RR criteria proved particularly effective in risk reclassification over Model 1 and Model 2: LVEF increase ≥1 category (severe [LVEF ≤30%], moderate [LVEF 31–40%], mild LV dysfunction [LVEF 41–55%] and normal LV function [LVEF ≥56%]), and LVEF increase >10 U. The same 2 criteria yielded independent prognostic significance and improved reclassification also in patients with LVEF <40% or LVEF ≤35%. LVEF increase ≥1 category and LVEF increase >10 U displayed a stronger prognostic value than LVESV reduction ≥15%, both in the whole population and the subsets with LVEF <40% or ≤35%. Funding Acknowledgement: Type of funding sources: None.