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Adverse Structural Remodeling of the Left Ventricle and Ventricular Arrhythmias in Patients with Depressed Ejection Fraction.
MedLine Citation:
PMID:  25463741     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The relation of life threatening ventricular arrhythmias to specific patterns of adverse LV remodeling has not been reported. We examined the relationship of ventricular tachycardia and/or fibrillation (VT/VF) to the pattern of left ventricular (LV) structural remodeling and to the degree of LV dysfunction in patients with a low ejection fraction (EF).
METHODS AND RESULTS: Data from 127 patients with a low EF (<0.45) and an implantable cardioverter-defibrillator (ICD) were examined and VT/VF was identified by ICD device interrogation. Echocardiographic data were used to define LV structural remodeling (eccentric hypertrophy, concentric remodeling/hypertrophy, and normal geometry). VT/VF occurred in 26% of the 127 patients. VT/VF was more common in the 60 patients with LV hypertrophy vs. the 67 with normal LV mass (40 vs. 13%, p=0.001) and in the 61 patients with LV enlargement vs. the 66 with a normal chamber size (34 vs. 18%, p=0.04). When LV chamber size, wall mass, and geometry were assessed in a combinatorial fashion, a Kaplan-Meier analysis indicated that the occurrence of VT/VF was highest in the patients with eccentric hypertrophy (43%), intermediate in those with concentric remodeling/hypertrophy (30%), and lowest (12%) in those with normal geometry (all p< 0.02). The EF was similar (p=ns) in these three groups with distinctly different patterns of remodeling.
CONCLUSIONS: Life threatening ventricular arrhythmias in patients with a low EF are related to the pattern of LV remodeling, not the degree of LV dysfunction. Risk stratification of such patients might be improved by a consideration of the pattern of LV remodeling.
Authors:
Timothy S Draper; Jonathan S Silver; William H Gaasch
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-6
Journal Detail:
Title:  Journal of cardiac failure     Volume:  -     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-12-2     Completed Date:  -     Revised Date:  2014-12-3    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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