ARTICLE
Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy**
Miguel A. Quiñones, MD, FACC*,
Barry H. Greenberg, MD, FACC ,
Helen A. Kopelen, RDMS*   || ¶,
Chris Koilpillai, MD,
Marian C. Limacher, MD, FACC,
Daniel M. Shindler, MD, FACC||,
Brent J. Shelton, PhD¶,
Debra H. Weiner, MPH* || ¶ for the SOLVD Investigators**
* Divisions of Cardiology, Baylor College of Medicine, Houston, Texas, USA
Oregon Health Sciences University, Portland, Oregon, USA
Dalhousie University, Halifax, Nova Scotia, Canada
University of Florida College of Medicine, Gainesville, Florida, USA
|| Robert Wood Johnson School of Medicine, Piscataway, New Jersey, USA
¶ Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
Manuscript received October 6, 1998;
revised manuscript received October 20, 1999,
accepted December 15, 1999.
Reprint requests and correspondence: Dr. Miguel A. Quiñones, Professor of Medicine, Director, Echocardiography Laboratory, Baylor College of Medicine, The Methodist Hospital, Section of Cardiology, 6550 Fannin, SM-677, Houston, Texas 77030
guelq{at}bcm.tmc.edu
OBJECTIVES
To assess the relation of left ventricular (LV) and left atrial (LA) dimensions, ejection fraction (EF) and LV mass to subsequent clinical outcome of patients with LV dysfunction enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) Registry and Trials.
BACKGROUND
Data are lacking on the relation of LV mass to prognosis in patients with LV dysfunction and on the interaction of LV mass with other measurements of LV size and function as they relate to clinical outcome.
METHODS
A cohort of 1,172 patients enrolled in the SOLVD Trials (n = 577) and Registry (n = 595) had baseline echocardiographic measurements and follow-up for 1 year.
RESULTS
After adjusting for age, New York Heart Association (NYHA) functional class, Trial vs. Registry and ischemic etiology, a 1-SD difference in EF was inversely associated with an increased risk of death (risk ratio, 1.62; p = 0.0008) and cardiovascular (CV) hospitalization (risk ratio, 1.59; p = 0.0001). Consequently, the other echo parameters were adjusted for EF in addition to age, NYHA functional class, Trial vs. Registry and ischemic etiology. A 1-SD difference in LV mass was associated with increased risk of death (risk ratio of 1.3, p = 0.012) and CV hospitalization (risk ratio of 1.17, p = 0.018). Similar results were observed with the LA dimension (mortality risk ratio, 1.32; p < 0.02; CV hospitalizations risk ratio, 1.18; p < 0.04). Likewise, LV mass  298 g and LA dimension 4.17 cm were associated with increased risk of death and CV hospitalization. An end-systolic dimension >5.0 cm was associated with increased mortality only. A protective effect of EF was noted in patients with LV mass 298 g (those in the group with EF >35% had lower mortality) but not in the group with LV mass <298 g.
CONCLUSIONS
In patients with LV dysfunction enrolled in the SOLVD Registry and Trials, increasing levels of hypertrophy are associated with adverse events. A protective effect of EF was noted in patients with LV mass 298 g (those in the group with EF >35% fared better) but not in the group with LV mass <298 g. These data support the development and use of drugs that can inhibit hypertrophy or alter its characteristics.
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Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | CHF | = congestive heart failure | | CV | = cardiovascular | | EF | = ejection fraction | | LA | = left atrium | | LV | = left ventricle | | NYHA | = New York Heart Association | | SD | = standard deviation | | SOLVD | = Studies of Left Ventricular Dysfunction |
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