Key result
Small left ventricle is linked to ~45% higher 1-year MACE risk in CAD patients.
Why the study?
The prognosis of a small left ventricle in patients with coronary artery disease and its correlation with cardiovascular events have not been fully investigated.
Does having a small or large left ventricle compared to a normal-sized left ventricle increase the 1-year risk of major adverse cardiovascular events in hospitalized patients with coronary artery disease?
Cohort (n=38,881)
Yes
Does having a small or large left ventricle compared to a normal-sized left ventricle increase the 1-year risk of major adverse cardiovascular events in hospitalized patients with coronary artery disease?
Hazard Ratio: 1.45 (95% CI 1.16–1.8)
Absolute Event Rate: 36.95% vs 24.33%
p-value: p=<0.001
In patients with coronary artery disease, a small left ventricular end-diastolic diameter is independently associated with an increased 1-year risk of major adverse cardiovascular events, all-cause mortality, and myocardial infarction, establishing a U-shaped relationship between LV size and clinical outcomes.
Small LV size may flag higher-risk CAD patients for closer monitoring; leaves open whether LVEDD improves risk stratification beyond existing models.
The prognosis of a small left ventricle (LV) in patients with coronary artery disease (CAD), as well as its inherent correlation with the occurrence of cardiovascular events, remains not fully investigated. To evaluate the association between a small LV and the risk of cardiovascular events in patients with coronary artery disease. We conducted a retrospective analysis of data from the Prospective Registry of the Current Status of Care for Patients with Coronary Artery Disease database, all participants with full data of conventional transthoracic echocardiography between Jan 2022 and Sep 2024 were collected. According to the American Society of Echocardiography guidelines, participants were categorized by left ventricular end-diastolic diameter (LVEDD) as having a small, normal (42.0–58.4 mm in men and 37.8–52.2 mm in women), or large LV. Cox proportional hazards models were used to assess the association between LV size and the 1-year major adverse cardiovascular events (MACE), defined as all-cause death, myocardial infarction, stroke or heart failure. Among 38,881 participants, 2,550 (6.6%) had a small LV, 35,299 (90.8%) normal, and 1,032 (2.7%) large. The small LV group exhibited older age, smaller stature, higher LVEF level. Compared with the normal LV group, both the small LV and large LV groups showed significantly increased rates of MACE (adjusted hazard ratio [aHR]: small LV: 1.45, 95% confidence interval [95% CI]: 1.16–1.80; large LV:1.54, 95% CI:1.20–1.97). The risk of all-cause death was also significantly elevated in the small LV group (aHR: 1.67, 95% CI: 1.27–2.21). Further analysis revealed a clear U-shaped association between LVEDD and MACE ( P nonlinear < 0.001). These findings indicating the association between small LV and high cardiovascular event risk in CAD patients, which provides new insights for optimizing prognostic management in this population.
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Zhang et al. (2026) conducted a cohort in Coronary artery disease (n=38,881). Small left ventricle (LVEDD < 42.0 mm in men or < 37.8 mm in women) vs. Normal left ventricle (LVEDD 42.0-58.4 mm in men and 37.8-52.2 mm in women) was evaluated on 1-year major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, stroke, or heart failure (HR 1.45, 95% CI 1.16-1.80, p=<0.001). Small left ventricle was independently associated with a higher 1-year risk of MACE compared with normal LV in patients with coronary artery disease (aHR 1.45, 95% CI 1.16-1.80, P<0.001).
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