Ventricular-Arterial Coupling, Remodeling, and Prognosis in Chronic Heart Failure

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• 作者：Bonnie Ky ; Benjamin French ; Abigail May Khan ; Ted Plappert ; Andrew Wang ; Julio A. Chirinos ; James C. Fang ; Nancy K. Sweitzer ; Barry A. Borlaug ; David A. Kass ; Martin St. John Sutton ; Thomas P. Cappola
• 关键词：ejection fraction ; heart failure ; mechanics
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：24 September, 2013
• 年：2013
• 卷：62
• 期：13
• 页码：1165-1172
• 全文大小：301 K

文摘

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Objectives

The objective of this study was to compare the physiological determinants of ejection fraction (EF)¡ªventricular size, contractile function, and ventricular-arterial (VA) interaction¡ªand 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 [Ees_sb] and intercept [V₀]); and VA coupling (arterial elastance [Ea]/Ees_sb). 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/Ees_sb (HR: 2.1; 95 % CI: 1.3 to 3.3). EDV,?V₀, and Ea/Ees_sb were also associated with risk of cardiac hospitalization. Ees_sb 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 (Ees_sb) is not. Assessment of VA coupling via Ea/Ees_sb is an additional noninvasively derived metric that can be used?to gauge prognosis in human HF.