August 25, 2026Journal of the American College of Cardiology246 citationsOpen Access
Ventricular-Arterial Coupling, Remodeling, and Prognosis in Chronic Heart Failure
Resultado clave
Ejection fraction (HR 3.0; 95% CI 1.8-5.0), end-diastolic volume, V0, and ventricular-arterial coupling were independently associated with death, transplantation, or VAD placement.
Puntos clave
- To compare the individual physiological determinants of ejection fraction—including ventricular size, contractile function, and ventricular-arterial interaction—and establish their associations with clinical outcomes in chronic heart failure.
- Assessed 466 participants with chronic systolic heart failure using quantitative echocardiography to determine end-diastolic volume (EDV), contractile function parameters (Eessb, V0), and ventricular-arterial coupling (Ea/Eessb).
- Followed patients over a median of 3.4 years for the composite primary endpoint of death, cardiac transplantation, or ventricular assist device (VAD) placement, as well as secondary cardiac hospitalizations.
- During follow-up, 76 deaths, 52 cardiac transplantations, 14 VAD placements, and 684 cardiac hospitalizations occurred.
- The primary composite outcome was independently predicted by EF (adjusted HR: 3.0; 95% CI: 1.8 to 5.0), EDV (HR: 2.6; 95% CI: 1.5 to 4.2), V0 (HR: 3.6; 95% CI: 2.1 to 6.1), and Ea/Eessb (HR: 2.1; 95% CI: 1.3 to 3.3) comparing third to first tertiles.
- EDV, V0, and Ea/Eessb independently associated with cardiac hospitalization risk, whereas end-systolic elastance (Eessb) showed no significant association with adverse outcomes after adjustment.
Diseño del estudio
Tipo
Cohort (n=466)
PICO estructurado
Do quantitative echocardiographic measures of ventricular-arterial coupling and remodeling predict adverse outcomes in patients with chronic systolic heart failure?
P
Población
466 participants with chronic systolic heart failure followed for a median of 3.4 years.
E
Exposición
Assessment of quantitative echocardiographic measures including cardiac size (end-diastolic volume [EDV]), contractile function (end-systolic pressure volume relationship slope [Eessb] and intercept [V0]), and ventricular-arterial coupling (arterial elastance [Ea]/Eessb)
O
Resultado
Combined endpoint of death, cardiac transplantation, or ventricular assist device (VAD) placementcomposite
Noninvasive assessment of ventricular-arterial coupling (Ea/Eessb) and left ventricular size provides prognostic value beyond ejection fraction in chronic systolic heart failure.
Resultado numérico
Hazard Ratio: 3 (95% CI 1.8–5)
Resumen
Objectives The objective of this study was to compare the physiological determinants of ejection fraction (EF)—ventricular size, contractile function, and ventricular-arterial (VA) interaction—and their associations with clinical outcomes in chronic heart failure (HF). Background EF is a potent predictor of HF outcomes, but represents a complex summary measure that integrates several components including left ventricular size, contractile function, and VA coupling. The relative importance of each of these parameters in determining prognosis is unknown. Methods In 466 participants with chronic systolic HF, we derived quantitative echocardiographic measures of EF: cardiac size (end-diastolic volume EDV); contractile function (the end-systolic pressure volume relationship slope Eessb and intercept V0); and VA coupling (arterial elastance Ea/Eessb). We determined the association between these parameters and the following adverse outcomes: 1) the combined endpoint of death, cardiac transplantation, or ventricular assist device (VAD) placement; and 2) cardiac hospitalization. Results Over a median follow-up of 3.4 years, there were 76 deaths, 52 transplantations, 14 VAD placements, and 684 cardiac hospitalizations. EF was independently associated with death, transplantation, and VAD placement (adjusted hazard ratio HR: 3.0; 95% confidence interval CI: 1.8 to 5.0 comparing third and first tertiles), as were EDV (HR: 2.6; 95% CI: 1.5 to 4.2); V0 (HR: 3.6; 95% CI: 2.1 to 6.1); and Ea/Eessb (HR: 2.1; 95% CI: 1.3 to 3.3). EDV, V0, and Ea/Eessb were also associated with risk of cardiac hospitalization. Eessb was not significantly associated with any adverse outcomes in adjusted analyses. Conclusions Left ventricular size, V0, and VA coupling are associated with prognosis in systolic HF, but end-systolic elastance (Eessb) is not. Assessment of VA coupling via Ea/Eessb is an additional noninvasively derived metric that can be used to gauge prognosis in human HF.