Patients with heart failure show a wide spectrum of changes in left ventricular volume, mass, and function.
The aims of this study were to define the patterns of left ventricular structural and functional remodeling and consider their clinical implications in patients with chronic heart failure.
PATIENTS AND METHODS:
Two-dimensional echocardiograms were obtained for patients with chronic heart failure in Baghdad teaching hospital during the period from February 2009 to February 2011 and were used to calculate left ventricular volume, mass, geometry, and ejection fraction. Inclusion required the diagnosis of heart failure in symptomatic patients on medical therapy. Measures of left ventricular size or function were not used as inclusion or exclusion criteria.
Two hundred and eighty (280) patients were included in this study of whom 154 were males and 126 were females. The mean age of patients was 58 ± 17 years. Plots of ejection fraction against left ventricular end-diastolic volume showing an inverse curvilinear relation allowed a description of 4 remodeling patterns. Pattern A (n = 58) was defined as normal end-diastolic volume (<91 ml/m2) and normal ejection fraction (>50%); 67.24% of these patients showed left ventricular hypertrophy or concentric remodeling. Pattern B (n = 58) was defined as normal end-diastolic volume and depressed ejection fraction; hypertrophy or concentric remodeling was present in 65.51%. Pattern C (n = 153) was defined as increased end-diastolic volume and depressed ejection fraction; eccentric hypertrophy was present in 94.77%. Pattern D (n = 11) was defined as increased end-diastolic volume and normal ejection fraction; eccentric hypertrophy was present in 81.81%.
These patterns of remodeling encompass a wide spectrum of geometric changes with different clinical and pathophysiologic features and possibly different management strategies.