LV SIZE NEEDS TO BE INCORPORATED IN LV FUNCTION ASSESSMENT IN HFREF PATIENTS

Background: Left ventricular (LV) size is associated with outcome in HFrEF patients, but neglected in the assessment of LV performance. We have aimed to develop and test the new parameter integrating the information about both LV function and size.
Methods and Results: A group of 844 stable patients with advanced HFrEF (57.9±11.3 years, 67.9% NYHA III/IV, LVEF 23.6±5.8) underwent an echocardiographic evaluation and were prospectively followed for a median of 1110 days (IQRs 407, 1780 days) for the occurrence of an adverse outcome (death, urgent heart transplantation or mechanical circulatory support implantation) that was observed in 512 patients (60,7%). LV size (LV-end-diastolic diameter indexed for body size, LVEDDi) was associated with adverse outcome even when adjusted for LV ejection fraction (HR 1.04, 95% CI 1.02- 1.06, p= 0.0001). In order to integrate LV size and function into one score parameter, we have developed a parameter called missing LV-ejection fraction (calculated as 55- LVEF) and LV-global dysfunction score (LVGDs), defined as missing EF times LVEDDi. LVGDs showed a superior prognostic role compared to LVEF (∆AUC ≥ 2.2 in four defined time points, p< 0.05). When subdivided into quartiles according to LVGDs, in each quartile patients with better LVEF but more dilated LV had similar outcome as those with worse LVEF but smaller LV size (p> 0.23).
Conclusion: LV dilatation is a manifestation of LV dysfunction in HFrEF patients. Integrating both LV size and LVEF into one parameter provides more accurate information about the degree of LV disease and prognosis.