Heart's small left ventricle with thick walls can be the strongest predictor of morphologic remodeling, says a new study. This is most likely to be considered as a first step towards heart failure in patients with chronic ischemic heart disease.
According to study coordinators Frank Rademakers and Jan D'Hooge, the results of the DOPPLER-CIP (Determining Optimal non-invasive Parameters for the Prediction of Left ventricular morphologic and functional Remodeling in Chronic Ischemic Patients) study were not expected and, if confirmed by other studies, could completely change risk stratification among patients with stable coronary artery disease.
Investigators from the University of Leuven, Belgium, said that the general belief was that larger ventricles with thin walls would be at higher risk of remodelling, with a possible explanation for this being that there is an increased wall stress in such hearts.
The findings showed that it was actually small hearts with thick walls that are more at risk. As this goes against general belief, they have checked and re-checked the data and analysis, and have run several consistency tests, but they all led to this same conclusion. The study included 676 patients, from 6 European countries, with suspicion of chronic ischemic heart disease. The patients underwent standard diagnostic tests at baseline including: electrocardiogram (ECG), exercise testing with continuous ECG monitoring, and measurement of maximal oxygen uptake (VO2max), as well as blood sampling and quality of life assessments.
At the end of the study period, about 20% of the subjects had evidence of cardiac remodelling based on MRI or ECHO results, with the best baseline predictors of this remodelling being left ventricular size measured as the "left ventricular end-diastolic volume" (LV EDV) and left ventricular mass (LVM) The study was presented in the annual meeting of European Society of Cardiology.