A small left ventricle (LV) with thick walls is the "strongest predictor of morphologic remodeling," in patients with chronic ischemic heart disease, according to results of the DOPPLER-CIP trial presented Aug. 30 at ESC Congress 2015 in London.

The study looked at 676 patients from six European countries with a suspicion of chronic ischemic heart disease who underwent standard diagnostic testing at baseline, including: electrocardiogram (ECG), exercise testing with continuous ECG monitoring, and measurement of maximal oxygen uptake, as well as blood sampling and quality of life assessments. They also underwent at least two stress imaging tests. Patients then received optimal, guideline-based treatment including revascularization, partial revascularization or pharmacologic treatment.

Results showed that after two years, about 20 percent of subjects had evidence of cardiac remodeling based on magnetic resonance imaging or echocardiography results, with "the best baseline predictors of this remodeling being LV size measured as the 'LV end-diastolic volume' (LVEDV) and LV mass."

The investigators note that specifically, a small LVEDV (< 145 ml) at baseline had a 25 – 40 percent change of remodeling, compared to a larger end-diastolic volume, which had a decreased risk (20 percent; P<0.001), with risk also increasing with increasing wall thickness. (P=0.003).

The investigators note that their findings, "were surprising," and if confirmed in further studies, "could completely change risk stratification among patients with stable coronary artery disease."

"By identifying baseline LVEDV and LV mass – measurements that can easily be assessed with standard imaging – as the best predictors of future remodeling and potentially heart failure risk, our study could guide clinicians away from more expensive tests for risk assessment," note Frank Rademakers, MD, and Jan D'Hooge, PhD, the study coordinators.

Keywords: Ventricular Remodeling, ESC Congress, Ventricular Function, Left

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