Abstract 12761: The Association of Resting and Exercise Ventricular-Vascular Coupling With Heart Failure Hospitalization in Patients With Stable Coronary Heart Disease and Preserved Systolic Function: The Heart and Soul Study
Introduction: The ventricular-vascular coupling ratio (EA/EES) is defined as the ratio of arterial (EA) to left ventricular elastance (EES) and is a key determinant of cardiac performance. Contractile reserve with exercise is inversely related to changes in the EA/EES in healthy patients. However, the prognostic value of the EA/EES at rest and its change with exercise has not been evaluated in patients with stable coronary heart disease (CHD) and preserved systolic function.
Methods: Among 647 patients with stable CHD and left ventricular ejection fraction ≥50%, we evaluated the association of baseline echocardiographically-determined EA, EES, and EA/EES, at rest and at peak exercise, with subsequent heart failure hospitalization (HF) during 7.5±2.8 years of follow-up.
Results: Both EA (2.1±0.7 to 3.0±1.6 mmHg/mL, p<0.001) and EES (4.0±1.63 to 7.0±4.5 mmHg/mL, p<0.001) increased significantly with exercise compared to rest. EA/ EES decreased from 0.67±0.40 at rest to 0.63±0.52 at peak exercise (p=0.001). Overall, 75 (12%) patients were hospitalized for HF. In multivariable adjusted models, participants with higher resting EES (HR 0.75 per mmHg/mL increase, 95% CI 0.61 - 0.89, p = 0.004) were at lower risk for HF hospitalization while those with higher resting EA/EES (HR 5.0 per unit increase, 95% CI 1.19 - 12.85, p<0.001) were at increased risk for HF hospitalization. With exercise, each doubling of EA/EES was associated with a 25% increased risk of incident HF in the fully adjusted model (H.R. 1.25 per doubling, 95% C.I. 1.08-1.45, p<0.002). Neither resting EA nor its change with exercise predicted HF hospitalization.
Conclusions: In patients with stable CHD and preserved systolic function, EA/EES decreases with exercise while both its components, arterial and ventricular elastance, increase. A higher resting EA/EES and its increase with exercise are independently associated with an increased risk of HF hospitalization.
Author Disclosures: J.K. Fitzpatrick: None. N.B. Schiller: Employment; Modest; UCSF. Other Research Support; Modest; Various Donors. Speakers Bureau; Modest; GE Healthcare and Lantheus. Consultant/Advisory Board; Modest; Cardiocore. M.A. Whooley: None. R.K. Mishra: None.
- © 2016 by American Heart Association, Inc.