Left Ventricular Size and Mortality Risk in Heart Failure

A Chinese nationwide study of 273,921 patients hospitalized with heart failure (HF) found a U-shaped association between left ventricular end-diastolic diameter (LVEDD) and mortality, with both abnormally small and abnormally large left ventricles independently associated with higher all-cause mortality. Using data from the Chinese Cardiovascular Association Database–Heart Failure Center Registry, this multicenter cohort included patients from 723 centers across 31 provincial-level administrative regions in mainland China between January 2018 and May 2022. Compared with patients with normal LV size, those with a small LV had a 32% higher adjusted risk of all-cause mortality (adjusted HR, 1.32), while those with a large LV had a 38% higher risk (adjusted HR, 1.38); a similar U-shaped relationship was observed for cardiovascular mortality. Sex-specific optimal LVEDD thresholds were 47 mm for men and 43 mm for women, and each 1-mm deviation from these thresholds was associated with a significant increase in mortality risk. The findings remained consistent across prespecified subgroups, with LVEDD indexed to body surface area, and in extensive sensitivity analyses, including competing-risk and complete-case analyses. These results suggest that both unusually small and unusually large left ventricular size are markers of increased mortality risk in HF, supporting incorporation of LV size into routine risk stratification and personalized HF management. Source: https://jamanetwork.com/