ࡱ> 352[ 0bjbj77 .U\U\     8V$zyyyFHHHHHH$K"l $yy$$l  $  F$F\DP)R20#L## "yCtGyyyllDyyy$$$$#yyyyyyyyy> :  ADVERSE LEFT VENTRICULAR REMODELING, INCIDENT HEART FAILURE, AND VENTRICULAR ARRHYTHMIAS W.H. Gaasch Department of Cardiovascular Medicine, Lahey Clinic, Burlington, MA, USA. Objective: To examine the association of adverse left ventricular (LV) remodeling with the eventual development of 1) heart failure and 2) ventricular arrhythmias. Methods: The patterns of structural remodeling used herein were based on those originally described by Linzbach (AJC. 1960; 5:370) and later expanded by Gaasch and Zile (JACC. 2011; 58:1733). LV chamber enlargement is described as eccentric geometry with or without LV hypertrophy (LVH); normal chamber size is described as concentric geometry with or without LVH; relative wall thickness (RWT) was also examined Results: Baseline echocardiographic data from 3181 participants (age>65) in the Cardiovascular Health Study were examined and outcome data were obtained 13 years later. In eccentric geometry with increased LV mass (eccentric LVH, n=191) incident heart failure (IHF) was more common (37 vs 29%, p=0.02) than in eccentric geometry without LVH (n= 286). In concentric geometry and LVH (concentric LVH, n=223), IHF was more common (32 vs 16%, p= 0.001) than in those without LVH (n=2481). In concentric geometry without LVH, IHF was more common in those with RWT>0.42 (concentric remodeling) than in those with RWT< 0.42 (21vs15%, p=0.01). When LV enlargement and/or LVH was present, RWT did not affect IHF rate. In a separate study of 129 patients with a low LV ejection fraction (EF<0.45) and an implantable cardiac defibrillator, the occurrence of ventricular tachycardia/fibrillation (VT/VF, device interrogation) was 43% in patients with eccentric LVH, 30% in concentric LVH/remodeling, and 12% in normal geometry (p<0.02). Duration of follow up was 3.5-4 years. The EF was similar in these three groups (29,30,31% respectively, p=ns) with distinctly different patterns of structural remodeling Conclusion: Different patterns of LV remodeling defined by measurement of LV chamber size and wall mass are associated with significant differences in IHF and VT/VF. 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