Left Ventricular Reverse Remodeling After Revascularization and Its Predictive Role for Survival

Aims For patients with ischemic heart failure who underwent revascularization, ejection fraction (EF) improvement is a major predictor of survival benefit. However, the association between left ventricular (LV) remodeling and outcomes has not been well-established. The aim of the study is to investigate the extent of LV remodeling after revascularization and its predictive role for long-term survival. Methods Patients with reduced EF (≤40%), who underwent either coronary artery bypass grafting or percutaneous coronary intervention, and had echocardiography reassessment 3 months after revascularization were enrolled in a real-world cohort study (No. ChiCTR2100044378). Patients were categorized into 4 groups according to whether LV end-systolic dimension (LVESD) reduction was ≤7% or >7%, and absolute EF improvement ≤5% or >5% Results A total of 923 patients were identified. The percentage of LVESD reduction was 4.5±18.4%. The median follow-up time was 3.4 years, during which 123 patients died. Patients with greater percentage of LVESD reduction had lower risk of all-cause death (hazard ratio [HR] per 1% decrement in LVESD, 0.98; 95% CI, 0.97-0.99; P <.001). A reduction in LVESD of 7.2% was the optimal cutoff value to predict survival. Compared to patients with LVESD reduced and EF improved, 2.11-fold (95% CI, 1.04-4.29), 3.56-fold (95% CI, 1.60-7.91), and 7.54-fold (95% CI, 4.20-13.53) higher mortality were found in LVESD unreduced but EF improved, LVESD reduced but EF unimproved, and LVESD unreduced and EF unimproved group, respectively. Conclusions After revascularization among patients with ischemic HF, a reduction in LVESD of 7% signifies clinically relevant revers remodeling. Combination of EF improvement and LVESD reduction might be more clinically precise approach of risk stratification in this population. Clinical Trial Registration The name of the registry: Coronary Revascularization in Patients with Ischemic Heart Failure and Prevention of Sudden Cardiac Death. Registration number: ChiCTR2100044378 (). ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial Registration number: ChiCTR2100044378 (). ### Funding Statement No external funding was received. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the ethics committee of theBeijingAnzhenHospital(No. 2021004X).Becausethis was a retrospective cohort study, written informed consent from the patients was waived. The study conforms with World Medical Association Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.