Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure

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

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1165-1172
Number of pages8
JournalJournal of the American College of Cardiology
Volume62
Issue number13
DOIs
StatePublished - Sep 24 2013
Externally publishedYes

Fingerprint

Heart-Assist Devices
Heart Failure
Confidence Intervals
Systolic Heart Failure
Hospitalization
Ventricular Function
Transplantation
Heart Transplantation
Stroke Volume
Blood Pressure

Keywords

  • ejection fraction
  • heart failure
  • mechanics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ky, B., French, B., May Khan, A., Plappert, T., Wang, A., Chirinos, J. A., ... Cappola, T. P. (2013). Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. Journal of the American College of Cardiology, 62(13), 1165-1172. https://doi.org/10.1016/j.jacc.2013.03.085

Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. / Ky, Bonnie; French, Benjamin; May Khan, Abigail; Plappert, Ted; Wang, Andrew; Chirinos, Julio A.; Fang, James C.; Sweitzer, Nancy K; Borlaug, Barry A.; Kass, David A.; St. John Sutton, Martin; Cappola, Thomas P.

In: Journal of the American College of Cardiology, Vol. 62, No. 13, 24.09.2013, p. 1165-1172.

Research output: Contribution to journalArticle

Ky, B, French, B, May Khan, A, Plappert, T, Wang, A, Chirinos, JA, Fang, JC, Sweitzer, NK, Borlaug, BA, Kass, DA, St. John Sutton, M & Cappola, TP 2013, 'Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure', Journal of the American College of Cardiology, vol. 62, no. 13, pp. 1165-1172. https://doi.org/10.1016/j.jacc.2013.03.085
Ky, Bonnie ; French, Benjamin ; May Khan, Abigail ; Plappert, Ted ; Wang, Andrew ; Chirinos, Julio A. ; Fang, James C. ; Sweitzer, Nancy K ; Borlaug, Barry A. ; Kass, David A. ; St. John Sutton, Martin ; Cappola, Thomas P. / Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 13. pp. 1165-1172.
@article{b122c503df4149e9ba9193b136ca8709,
title = "Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure",
abstract = "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.",
keywords = "ejection fraction, heart failure, mechanics",
author = "Bonnie Ky and Benjamin French and {May Khan}, Abigail and Ted Plappert and Andrew Wang and Chirinos, {Julio A.} and Fang, {James C.} and Sweitzer, {Nancy K} and Borlaug, {Barry A.} and Kass, {David A.} and {St. John Sutton}, Martin and Cappola, {Thomas P.}",
year = "2013",
month = "9",
day = "24",
doi = "10.1016/j.jacc.2013.03.085",
language = "English (US)",
volume = "62",
pages = "1165--1172",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "13",

}

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.

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

VL - 62

SP - 1165

EP - 1172

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 13

ER -