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Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure

Valsartan heart failure trial (Val-HeFT) echocardiographic data

Maylene Wong, MD, FACC^*,*, Lidia Staszewsky, MD, Roberto Latini, MD, Simona Barlera, MS, Robert Glazer, MD, Nora Aknay, BSc, Allen Hester, PhD, Inder Anand, MD, FACC, FRCP, DPhil (Oxon)^|| and Jay N. Cohn, MD, FACC^||

^* Veterans Affairs Greater Los Angeles Healthcare System, and David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA
Istituto di Recerche Farmacologiche "Mario Negri," Milan, Italy
Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
^|| University of Minnesota Medical School, Minneapolis, Minnesota, USA

View larger version (23K): [in a new window]   Figure 1 Kaplan-Meier survival curves by baseline quartiles of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) from pooled valsartan and placebo data acquired over an average of 23 months of observation after randomization. Differences among quartiles are significant (p < 0.00001 by the log-rank test).

View larger version (23K): [in a new window]   Figure 2 Response to treatment by baseline quartiles. Inter-treatment changes from baseline quartiles of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) at months 4, 12, and 24 and the end point are least-squares mean values by analysis of covariance. Open bars = placebo; solid bars = valsartan. Asterisks indicate significant placebo-subtracted changes from baseline, based on least-square mean values (p < 0.05). Global, across-quartile treatment differences at each time point are not significant.

View larger version (17K): [in a new window]   Figure 3 Risk by baseline quartiles—effect of valsartan (V) on the combined end point. Valsartan is compared with placebo (P) for M + M, summarized as percentage of events, risk ratios, and 95% confidence intervals, calculated using Cox regression analysis. The p values on the right are for global, across-quartile change. EF = ejection fraction; LVIDd = left ventricular internal diastolic diameter.