This nationwide cohort study examined whether left ventricular end-diastolic diameter (LVEDD) independently predicts mortality in 273,921 patients hospitalized with heart failure across 723 centers in China (enrolled January 2018–May 2022), categorized as small, normal, or large LV per ASE criteria.
A significant U-shaped association was found between LVEDD and mortality: both small LV (aHR 1.32; 95% CI 1.28–1.37) and large LV (aHR 1.38; 95% CI 1.35–1.40) independently raised all-cause mortality risk vs. normal LV. Sex-specific optimal thresholds were 47 mm (male) and 43 mm (female), with each 1-mm deviation from these values associated with significantly higher mortality.
- Observational registry design limits causal inference and residual confounding cannot be excluded. - Full text was not accessible for review; findings rely on the abstract alone, so details on follow-up duration, missing data handling, and covariate adjustment are not fully verifiable. - The cohort is exclusively Chinese, which may limit generalizability to other ethnic populations.
Routine echocardiographic LVEDD measurement should be incorporated into heart failure risk stratification — not just ejection fraction. Both a small and a large ventricle (below 43 mm in women or 47 mm in men, or significantly enlarged) signal elevated mortality risk and may warrant tailored management.
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