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Previous Volume 336:1350-1355 May 8, 1997 Number 19 Next

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ABSTRACT

Background Left ventricular dilatation is a well-recognized precursor of ventricular dysfunction and congestive heart failure after myocardial infarction. The effect of left ventricular dilatation on the risk of heart failure in people initially free of myocardial infarction is not known.

Methods We examined the relation of the left ventricular end-diastolic and end-systolic internal dimensions, as measured by M-mode echocardiography, to the risk of congestive heart failure in 4744 subjects (2661 women and 2083 men) who had not sustained a myocardial infarction and who were free of congestive heart failure. We used sex-stratified proportional-hazards regression to assess the association between base-line left ventricular internal dimensions and the subsequent risk of congestive heart failure, after adjusting for age, blood pressure, hypertension treatment, body-mass index, diabetes, valve disease, and interim myocardial infarction.

Results Over an 11-year follow-up period, congestive heart failure developed in 74 subjects (38 men and 36 women). The risk-factor–adjusted hazard ratio for congestive heart failure was 1.47 (95 percent confidence interval, 1.25 to 1.73) for an increment of 1 SD in the left ventricular end-diastolic dimension, indexed for height. We obtained similar results using the left ventricular end-systolic dimension (hazard ratio, 1.43; 95 percent confidence interval, 1.24 to 1.65).

Conclusions An increase in left ventricular internal dimension is a risk factor for congestive heart failure in men and women who have not had a myocardial infarction. Knowledge of the left ventricular dimension improves predictions of the risk of congestive heart failure made on the basis of traditional risk factors, perhaps by aiding in the identification of subjects with subclinical left ventricular dysfunction.

Source Information

From the Framingham Heart Study, Framingham, Mass. (R.S.V., M.G.L., E.J.B., J.C.E., D.L.); the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital and Harvard Medical School, Boston (D.L.); the Cardiology Section (E.J.B.) and the Department of Preventive Medicine and Epidemiology (R.S.V., M.G.L., E.J.B., D.L.), Boston University School of Medicine, Boston; and the National Heart, Lung, and Blood Institute, Bethesda, Md. (D.L.).

Address reprint requests to Dr. Levy at the Framingham Heart Study, 5 Thurber St., Framingham, MA 01701.

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