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.
Cohort (n=466)
Do quantitative echocardiographic measures of ventricular-arterial coupling and remodeling predict adverse outcomes in patients with chronic systolic heart failure?
Noninvasive assessment of ventricular-arterial coupling (Ea/Eessb) and left ventricular size provides prognostic value beyond ejection fraction in chronic systolic heart failure.
Hazard Ratio: 3 (95% CI 1.8–5)
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.
Ky et al. (Thu,) conducted a cohort in Chronic systolic heart failure (n=466). Ejection fraction (EF), end-diastolic volume (EDV), V0, and ventricular-arterial coupling (Ea/Eessb) vs. First tertile was evaluated on Combined endpoint of death, cardiac transplantation, or ventricular assist device (VAD) placement (HR 3.0, 95% CI 1.8 to 5.0). 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.