In patients with chronic coronary syndromes, a resting hypercontractile phenotype was associated with increased all-cause mortality compared to normal elastance (HR 1.531; 95% CI 1.116-2.099; p=0.006).
Cohort (n=10,677)
Yes
Does a hypercontractile phenotype at rest predict increased mortality and impaired functional reserve in patients with chronic coronary syndromes?
A hypercontractile phenotype at rest in chronic coronary syndromes is paradoxically associated with impaired functional reserve and increased all-cause mortality.
Hazard Ratio: 1.531 (95% CI 1.116–2.099)
Absolute Event Rate: 1.88% vs 1.03%
p-value: p=0.006
BACKGROUND: Transthoracic echocardiography (TTE) identifies a hypercontractile phenotype (HP) in chronic coronary syndromes (CCS), characterized by elevated resting left ventricular (LV) elastance (Force = systolic blood pressure/end-systolic volume). OBJECTIVES: To evaluate the prognostic significance and functional correlates of HP. METHODS: In a prospective multicenter study, 10,677 CCS patients underwent resting TTE to assess LV ejection fraction (EF), stroke volume (SV), and force by quantitative volumetric echocardiography. All patients were followed for the endpoint of all-cause mortality. In a subset of 5,834 patients, stress echocardiography (exercise or dobutamine) was performed for LV contractile reserve (LVCR) and heart rate reserve (HRR). RESULTS: Patients were stratified into Force quintiles (Q1-Q5). HP patients exhibited lower SV at rest (Q5=34.8±12.3 vs. Q1-Q4=57.4 ± 19.1 mL; p6.11 mmHg/mL; 1.88; p4.1 (present in 185, 3.2% of the population) survived. CONCLUSIONS: CCS patients with HP assessed by resting TTE demonstrate higher mortality and multilayered functional impairment, including reduced LV contractile and chronotropic reserves. HP improved the prediction of mortality by EF. A "stronger" heart is, in fact, functionally and prognostically weaker.
Ciampi et al. (Sat,) conducted a cohort in Chronic coronary syndromes (n=10,677). Hypercontractile phenotype (Force >6.11 mmHg/mL) vs. Normal resting elastance (Force quintile 3: 3.53-4.51 mmHg/mL) was evaluated on All-cause mortality (HR 1.531, 95% CI 1.116-2.099, p=0.006). In patients with chronic coronary syndromes, a resting hypercontractile phenotype was associated with increased all-cause mortality compared to normal elastance (HR 1.531; 95% CI 1.116-2.099; p=0.006).