Left Ventricular Reverse Remodeling After Revascularization and Its Predictive Role for Survival

AimsFor patients with ischemic heart failure who underwent revascularization, ejection fraction (EF) improvement is a major predictor of survival benefit. However, the association between left ventricular (LV) remodeling and outcomes has not been well-established. The aim of the study is to investigate the extent of LV remodeling after revascularization and its predictive role for long-term survival. MethodsPatients with reduced EF ([&le;]40%), who underwent either coronary artery bypass grafting or percutaneous coronary intervention, and had echocardiography reassessment 3 months after revascularization were enrolled in a real-world cohort study (No. ChiCTR2100044378). Patients were categorized into 4 groups according to whether LV end-systolic dimension (LVESD) reduction was [&le;]7% or >7%, and absolute EF improvement [&le;]5% or >5% ResultsA total of 923 patients were identified. The percentage of LVESD reduction was 4.5{+/-}18.4%. The median follow-up time was 3.4 years, during which 123 patients died. Patients with greater percentage of LVESD reduction had lower risk of all-cause death (hazard ratio [HR] per 1% decrement in LVESD, 0.98; 95% CI, 0.97-0.99; P<.001). A reduction in LVESD of 7.2% was the optimal cutoff value to predict survival. Compared to patients with LVESD reduced and EF improved, 2.11-fold (95% CI, 1.04-4.29), 3.56-fold (95% CI, 1.60-7.91), and 7.54-fold (95% CI, 4.20-13.53) higher mortality were found in LVESD unreduced but EF improved, LVESD reduced but EF unimproved, and LVESD unreduced and EF unimproved group, respectively. ConclusionsAfter revascularization among patients with ischemic HF, a reduction in LVESD of 7% signifies clinically relevant revers remodeling. Combination of EF improvement and LVESD reduction might be more clinically precise approach of risk stratification in this population. Clinical Trial RegistrationThe name of the registry: Coronary Revascularization in Patients with Ischemic Heart Failure and Prevention of Sudden Cardiac Death. Registration number: ChiCTR2100044378 (http://www.chictr.org.cn).