Left Ventricular End-Diastolic Diameter as a Risk Indicator in Coronary Artery Disease

Abstract

Previous studies have demonstrated that the presence of cardiomegaly on the routine chest roentgenogram in patients with coronary artery disease (CAD) constitutes a high-risk prognostic indicator. This study was designed to test the value of the measurement of the left ventricular end-diastolic diameter (LVEDD) on echocardiography, a more precise measure of left ventricular size than is offered by the routine chest roentgenogram, as a mortality risk indicator in patients with previous myocardial infarction. One hundred and twenty-three patients observed at an average of 14 months post-myocardial infarction, with a mean follow-up of 44 months, were studied. The normal mean ± 1 SD for LVEDD was 47.2 ± 4.3 mm. The upper normal limit of LVEDD was set at +2 SD from the normal mean (56 mm). Fifty-two patients had increased LVEDD (> 56 mm) and the remaining 71 had normal LVEDD (<56 mm). There were 28 cardiac deaths. Cumulative 5-year survival was 88% in patients with normal LVEDD and 55% in those with increased LVEDD (p = 0.0002). Patient groups with normal (< 56 mm), moderately increased (56-60) and markedly increased LVEDD (>60 mm) exhibited decreasing survival with increasing LVEDD (p = 0.0002). Multivariate analysis demonstrated that the LVEDD adds significantly to the risk stratification potency of left ventricular systolic function determined from the systolic time intervals.