Left Ventricular Geometrical Characterization in Patients With Diastolic Heart Failure

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Objectives. Conventional echocardiography was used to clarify left ventricular (LV) geometrical characterization in patients with preserved LV systolic function (diastolic heart failure, DHF).
Background. Despite a growing awareness of the importance of DHF, LV geometry has not been characterized in patients with DHF so far.
Methods. LV mass index (LVMI) and relative wall thickness (RWTh) were determined in 147 consecutive patients who fulfilled the following inclusion criteria: (1) presence of symptoms of HF, (2) pulmonary arterial systolic pressure that was estimated from continuous-wave Doppler tricuspid regurgitant velocity by applying simplified Bernoulli equation of 35mmHg or greater, and (3) preserved LV ejection fraction (>=0.50).
Results. LV geometry showed normal geometry (RWTh<0.41, LVMI<120 g/m²) in 49 patients (33%), concentric remodeling (RWTh>=0.41, LVMI<120 g/m²) in 39 patients (27%), concentric hypertrophy (RWTh>=0.41, LVMI>=120 g/m²) in 35 patients (24%), and eccentric hypertrophy (RWTh<0.41, LVMI>=120 g/m²) in 24 patients (16%). LV concentric geometry was more frequently observed in females than in males (55 vs. 46%). If those of 85 years or older were analyzed, the incidence of concentric remodeling increased to 47% while incidence of eccentric hypertrophy decreased to 6%.
Conclusions. Not only LV hypertrophy, but concentric geometry is an important contributor to the occurrence of DHF. Concentric geometry was particularly important in aged patients.