Key result
Preserved RWT is linked to ~74% lower all-cause mortality in ICM with restrictive filling.
Why the study?
The prognostic effects of left ventricular remodeling patterns in patients with ischemic cardiomyopathy and left ventricular restrictive filling pattern were not well established.
Does preserved relative wall thickness (RWT ≥ 0.34) improve survival and reduce heart failure readmissions compared to reduced RWT (< 0.34) in patients with ischemic cardiomyopathy and restrictive filling pattern?
Cohort (n=102)
No
Does preserved relative wall thickness (RWT ≥ 0.34) improve survival and reduce heart failure readmissions compared to reduced RWT (< 0.34) in patients with ischemic cardiomyopathy and restrictive filling pattern?
In patients with ischemic cardiomyopathy and restrictive filling pattern, preserved relative wall thickness (≥0.34) is associated with better clinical outcomes regarding mortality and heart failure readmissions.
May refine risk stratification in ischemic cardiomyopathy with restrictive filling; leaves open impact on management decisions.
BACKGROUND: To evaluate the effects of Left ventricular remodeling patterns in patients with left ventricular restrictive filling pattern (RFP; E/A>2) in ischemic cardiomyopathy (ICM) on prognosis. METHODS: Patient data was retrospectively analyzed over a period of 4.5 years to determine the effect of LV geometry by Echocardiographic parameterson survival and re-admission for heart failure. All patients with previous history of transmural myocardial infarction were studied and all were on guideline directed medical therapy. None underwent device therapy or surgery. The stored 2D Echocardiograms were studied. Left ventricular dimensions were noted, including the relative wall thickness (RWT). The patients were grouped based on RWT<0.34 and ≥ 0.34 and were compared for clinical outcomes of mortality and re-admissions for heart failure, over a period of 54 months. RESULTS: There were 102 ICM patients who had baseline RFP. We identified two sub-groups based on geometric phenotypes of left ventricular eccentric remodeling and dilated remodeling based on the relative wall thickness (RWT >0.34 or <0.34). The patients with preserved RWT had significantly more dilated ventricles (LVIDd and LVIDs), greater pulmonary artery systolic pressures (PASP), greater diatolic dysfunction (E/A) and less left ventricular ejection fraction (LVEF); p < 0.001. The number of deaths was higher in the reduced RWT patients, as were the number of re-admissions, although the time to survival and time to re-admission was not significant. CONCLUSIONS: In this pilot study on ICM patients in advanced heart failure with baseline RFP, the presence of preserved RWT indicative of eccentric remodelling demonstrated a better clinical outcome.
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Adhyapak et al. (2022) conducted a cohort in Ischemic cardiomyopathy with restrictive filling pattern (n=102). Preserved relative wall thickness (≥0.34) vs. Reduced relative wall thickness (<0.34) was evaluated on All-cause mortality (p=<0.001). Preserved relative wall thickness (≥0.34) was associated with a significantly lower proportion of total all-cause deaths (20.6% vs 79.4%) compared to reduced relative wall thickness in patients with ischemic cardiomyopathy and restrictive filling pattern.
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