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Aims  We aimed to examine temporal changes in left ventricular (LV) structures and their prognostic impacts in patients with heart failure (HF) and preserved ejection fraction (HFpEF).    Methods and results  In the Chronic Heart Failure Analysis and Registry in the Tohoku District‐2 (CHART‐2) study ( n  = 10 219), we divided 2698 consecutive HFpEF patients (68.9 ± 12.2 years, 32.1% female) into three groups by LV hypertrophy (LVH) and enlargement (LVE) at baseline: (−)LVH/(−)LVE ( n  = 989), (+)LVH/(−)LVE ( n  = 1448), and (+)LVH/(+)LVE ( n  = 261). We examined temporal changes in LV structures and their prognostic impacts during a median 8.7‐year follow‐up. From (−)LVH/(−)LVE, (+)LVH/(−)LVE to (+)LVH/(+)LVE at baseline, the incidence of the primary outcome, a composite of cardiovascular death or HF admission, significantly increased. Among 1808 patients who underwent echocardiography at both baseline and 1 year, we noted substantial group transitions from baseline to 1 year; the transition rates from (−)LVH/(−)LVE to (+)LVH/(−)LVE, from (+)LVH/(−)LVE to (−)LVH/(−)LVE, from (+)LVH/(−)LVE to (+)LVH/(+)LVE, and from (+)LVH/(+)LVE to (+)LVH/(−)LVE were 27% (182/671), 22% (213/967), 6% (59/967), and 26% (44/170), respectively. In the univariable Cox proportional hazard model, patients who transitioned from (+)LVH/(−)LVE to (+)LVH/(+)LVE or remained in (+)LVH/(+)LVE had the worst subsequent prognosis [hazard ratio (HR) 4.65, 95% confidence interval (CI) 3.09–6.99,  P  < 0.001; HR 4.01, 95% CI 2.85–5.65,  P  < 0.001, respectively], as compared with those who remained in (−)LVH/(−)LVE. These results were unchanged after adjustment for the covariates including baseline LV ejection fraction (LVEF) and 1‐year LVEF change.    Conclusion  In HFpEF patients, LV structures dynamically change over time with significant prognostic impacts, where patients who develop LVE with LVH have the worst prognosis.

Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction