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Small left ventricle predicts cardiac remodelling best

ESC Congress News 2015 - London

A small left ventricle (LV) with thick walls is the best non-invasive predictor of remodelling in patients with stable CAD, according to the Determining Optimal non-invasive Parameters for the Prediction of Left vEntricular morphologic and functional Remodeling in Chronic Ischemic Patients (DOPPLER-CIP) study presented at a Hot Line yesterday.

Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care

Jan D’hooge: Early detection of cardiac remodelling ‘critical’ for starting treatment in ischaemic patients.Investigator Jan D’hooge from the University of Leuven, Belgium, said the finding relating to small hearts ‘goes against’ the established hypothesis that risk is greater in hearts with larger ventricles. Early detection of the remodelling process is critically important to start treatment early, said D’hooge.

However, no large-scale studies have to date made a direct comparison between the different methods of predicting adverse morphologic remodelling or functional recovery of the myocardium after medical therapy.

The DOPPLER-CIP study aimed to compare these different non-invasive methods to determine which parameter has the best power to predict risk of cardiac remodelling two years later.

A total of 676 patients with suspected chronic ischaemic heart disease were recruited from six European countries. They underwent standard diagnostic tests at baseline and had at least two stress imaging tests including ECHO, MRI, and/or SPECT stress test, stress ECHO and stress MRI. Patients later received optimal guideline-based treatment including revascularisation, partial revascularisation, or pharmacologic treatment.

Results showed that around 20% of the subjects had evidence of cardiac remodelling based on MRI or ECHO results. The best baseline predictors of this remodelling were LV size measured as LV EDV and LVM.

A small LV EDV (<145 ml) at baseline had a 25-40 % chance of remodelling and a larger EDV had a 20% chance (P<0.001). The risk also increased with increasing wall thickness (P=0.003).