The Association between Left Ventricular End-Diastolic Diameter and Long-Term Mortality in Patients with Coronary Artery Disease

Qiang Li; Haozhang Huang; Xiaozhao Lu; Yajuan Yang; Yunhan Zhang; Weihua Chen; Wenguang Lai; Guoxiao Liang; Shanshan Shi; Xiaoyan Wang; Jiyan Chen; Shiqun Chen; Xiaoming Yan

doi:10.31083/j.rcm2403084

The Association between Left Ventricular End-Diastolic Diameter and Long-Term Mortality in Patients with Coronary Artery Disease

Rev Cardiovasc Med. 2023 Mar 8;24(3):84. doi: 10.31083/j.rcm2403084. eCollection 2023 Mar.

Authors

Qiang Li^{1

2}, Haozhang Huang^{1

2}, Xiaozhao Lu^{1

2}, Yajuan Yang³, Yunhan Zhang⁴, Weihua Chen⁵, Wenguang Lai^{1

2}, Guoxiao Liang^{1

2}, Shanshan Shi⁵, Xiaoyan Wang⁶, Jiyan Chen^{1

2}, Shiqun Chen^{1

2}, Xiaoming Yan⁷

Affiliations

¹ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China.
² Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China.
³ Department of Cardiology, The First People's Hospital of Foshan, 528000 Foshan, Guangdong, China.
⁴ Department of Ultrasound Medicine, Yunnan Fuwai Cardiovascular Hospital, Kunming Medical University, 650500 Kunming, Yunnan, China.
⁵ Department of Cardiology, The School of Clinical Medicine, Fujian Medical University, 364000 Longyan, Fujian, China.
⁶ Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, China.
⁷ Department of Information Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China.

Abstract

Background: Left ventricular end-diastolic diameter (LVEDD) is a common parameter in echocardiography. Increased LVEDD is associated with left ventricular (LV) dysfunction. However, the association between LVEDD and all-cause mortality in patients with coronary artery disease (CAD) is uncertain.

Methods: This study enrolled 33,147 patients with CAD who had undergone transthoracic echocardiography between January 2007 and December 2018 from the Cardiorenal Improvement study (NCT04407936). The patients were stratified into four groups based on the quartile of LVEDD (Quartile 1: LVEDD $\leq$ 43 mm, Quartile 2: 43 mm $<$ LVEDD $\leq$ 46 mm, Quartile 3: 46 mm $<$ LVEDD $\leq$ 51 mm, Quartile 4: LVEDD $>$ 51 mm) and were categorized into two groups (Quartile 1-3 versus Quartile 4). Survival curves were generated with the Kaplan-Meier analysis, and the differences between groups were assessed by log-rank test. Restricted cubic splines and cox proportional hazards models were used to investigate the association with LVEDD and all-cause mortality.

Results: A total of 33,147 patients (average age: 63.0 $\pm$ 10.6 years; 24.0% female) were included in the final analysis. In the average follow-up period of 5.2 years, a total of 4288 patients died. The mortality of the larger LVEDD group (Quartile 4) was significantly higher than the lower LVEDD groups (Quartile 1-3) (18.05% vs 11.15%, p $<$ 0.001). After adjusting for confounding factors, patients with the larger LVEDD (Quartile 4) had a 1.19-fold risk for all-cause mortality (95% CI: 1.09-1.30) compared with the lower quartile (Quartile 1-3).

Conclusions: Enlarged LVEDD is an independent predictor of all-cause mortality in patients with CAD. LVEDD measurements may be helpful for risk stratification and providing therapeutic targets for the management of CAD patients.

Keywords: coronary artery disease; left ventricular; left ventricular end-diastolic diameter; mortality; prognosis.

Grants and funding

This study was supported by Guangdong Provincial science and technology project (2020B1111170011). Multi-center study on key techniques for prevention, diagnosis and treatment of high risk coronary artery disease (DFJH2020026). Study on the function and mechanism of the potential target for early warning of cardiorenal syndrome after acute myocardial infarction based on transformism (DFJH201919). Natural Science Foundation of Guangdong Province General Project (2020A1515010940), and Guangdong Provincial science and technology project (KJ022021049). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript; the work was not funded by any industry sponsors.