TY - JOUR
T1 - Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure
AU - Ky, Bonnie
AU - French, Benjamin
AU - May Khan, Abigail
AU - Plappert, Ted
AU - Wang, Andrew
AU - Chirinos, Julio A.
AU - Fang, James C.
AU - Sweitzer, Nancy K.
AU - Borlaug, Barry A.
AU - Kass, David A.
AU - St. John Sutton, Martin
AU - Cappola, Thomas P.
N1 - Funding Information:
Dr. Ky was supported by the NIH/Clinical and Translational Science Award KL1 RR024132 , NIH K23 HL095661-01 , and the Heart Failure Society of America Research Fellowship Award. This work was also supported by NIH HL088577 (Dr. Cappola). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/9/24
Y1 - 2013/9/24
N2 - 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 [V 0]); 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.
AB - 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 [V 0]); 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.
KW - ejection fraction
KW - heart failure
KW - mechanics
UR - http://www.scopus.com/inward/record.url?scp=84884362647&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84884362647&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2013.03.085
DO - 10.1016/j.jacc.2013.03.085
M3 - Article
C2 - 23770174
AN - SCOPUS:84884362647
SN - 0735-1097
VL - 62
SP - 1165
EP - 1172
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 13
ER -