LV mass was computed by the Cube formula. Heart failure with preserved ejection fraction (HFpEF) was defined as an ejection fraction ≥50%.
Left ventricular ejection fraction (LVEF) was assessed using the biplane Simpson’s method. The patients were divided into two groups based on the median RWT PW (low- and high-RWT PW), median RWT IVS + PW (low- and high-RWT IVS + PW), or median RWT IVS (low- and high-RWT IVS). RWTs were calculated by the three measurement methods and defined as follows: RWT PW = 2 × PWth/LVDd RWT IVS + PW = (IVSth + PWth)/LVDd and RWT IVS = 2 × IVSth/LVDd. All measurements were performed from the leading edge to the leading edge. LV geometry, including PWth, IVSth, and LVDd, was measured in M-mode in a parasternal long-axis view. At least two attending cardiologists certified by the Japanese Circulation Society and an experienced sonographer reviewed the echocardiography reports immediately after comprehensive TTE. Their measurements followed established and standardized methods recommended by the ASE and the European Society of Cardiology. Transthoracic echocardiographyĬomprehensive TTE (Vivid 7 ultrasound system, GE Vingmed Ultrasound, Horten, Norway) was performed during hospital admission by four medical technicians who had at least 5 years of experience performing TTE. The institutional ethics committee at Tomishiro Central Hospital approved the present study and waived informed consent because of the observational nature of the study. The present study followed the tenets of the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects proposed by the Ministry of Health and Welfare in Japan. To compare the clinical significance of RWT PW, RWT IVS + PW, and RWT IVS, the prognostic values of the RWTs were examined and compared in patients with ADHF. The difference in clinical significance among the three methods of measuring RWT is unclear. However, some studies found that RWT IVS + PW had clinical significance. The American Society of Echocardiography (ASE) recommends RWT PW for calculating RWT. Therefore, there are three methods to calculate the RWT: RWT PW = 2 × PWth/LVDd RWT IVS + PW = (IVSth + PWth) LVDd and RWT IVS = 2 × IVSth/LVDd. LV wall thickness, which can be measured in a parasternal long-axis view by TTE, is represented by the Interventricular septum wall thickness (IVSth) and the posterior wall thickness (PWth). RWT is the ratio of LV wall thickness to the LV internal dimension at end diastole (LVDd). Relative wall thickness (RWT) is an index of LV concentricity.
Furthermore, we previously reported that a concentric LV structure evaluated by transthoracic echocardiography (TTE) was associated with poor survival in patients with acute decompensated heart failure (ADHF). A concentric LV structure is a risk factor for cardiovascular events in hypertensive patients. When calculating RWT, RWT PW should be recommended for evaluating the mortality risk in ADHF.Ī concentric left ventricular (LV) structure is the result of remodeling that occurs with LV wall thickening relative to the LV cavity to compensate for pressure overload. High-RWT IVS did not have significant prognostic value. Only the adjusted Cox model showed that High-RWT IVS + PW was associated with a significant risk of the primary outcome (unadjusted HR (95%CI), 1.45 (0.96–2.17), P = 0.07 adjusted HR, 1.53 (1.01–2.32), P = 0.045). High-RWT IVS + PW was not associated with poor survival on survival analysis or the unadjusted Cox model. Survival analysis was performed, and Cox proportional hazard models unadjusted and adjusted by Get With The Guideline score were used. A total of 389 hospitalized ADHF patients were divided into two groups based on the three median RWT values.
This was a single-center, retrospective, observational study at a Japanese community hospital.
The aim was to compare the prognostic values of these RWTs in patients with acute decompensated heart failure (ADHF). Thus, there are three methods to calculate relative wall thickness as follows: RWT PW = 2 × PWth/LVDd RWT IVS + PW = (IVSth + PWth) /LVDd and RWT IVS = 2 × IVSth/LVDd (IVSth = interventricular septum thickness LVDd = LV internal dimension at end-diastole PWth = posterior wall thickness). Left ventricular (LV) wall thickness can be measured at the posterior wall (PW) and the intraventricular septum (IVS) in a parasternal long axis view by transthoracic echocardiography.
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