Abstract 20531: Ventriculo-Arterial Coupling to Detect Hert Failure Symptoms in Patients With Severe Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction
Introduction: Identification of heart failure (HF) symptoms in patients with severe aortic regurgitation (AR) and preserved left ventricular (LV) ejection fraction (EF) is clinically important, but assessment of HF symptoms is challenging. In addition, HF symptoms in severe AR patients often occur irrespective of AR severity and LVEF, and its precisely detection can be difficult. End-systolic ventricular elastance (Ees), the slope of the end-systolic pressure-volume relationship, is thought to be a load-independent index of myocardial contractility. Moreover, VA coupling, which was calculated as the effective arterial elastance (Ea)/Ees, is considered to be the principal determinant of net cardiovascular performance.
Hypothesis: Our aim was thus to test the hypothesis that VA coupling is useful to detect HF symptoms in chronic severe AR patients with preserved LVEF.
Methods: We studied 33 chronic severe AR patients undergoing surgical correction with the LVEF of 60±5% (all >50%). Ees was estimated by using the non-invasive single-beat technique as previously described by Chen et al. Ea was calculated as LV end-systolic pressure divided by stroke volume, and VA coupling was calculated as Ea/Ees. The symptomatic status was defined as only HF symptoms, and was carefully assessed by at least three senior cardiologists. The extent of dyspnea was classified with the New York Heart Association functional classification.
Results: Thirteen (39%) patients were characterized as symptomatic, and the remaining 20 as asymptomatic. An important finding of the multivariate logistic regression analysis was that Ea/Ees was the only independent determinant of symptomatic status (odds ratio: 0.242; 95% confidential interval: 0.101-0.583; p=0.006). In addition, the receiver operating characteristic curve analysis showed that Ea/Ees>1.52 was predictive of symptomatic status for patients with severe AR with a sensitivity of 67%, specificity of 90%, and the area under the curve of 0.792 (p=0.002).
Conclusions: The assessment of VA coupling may well have clinical implications for better management of chronic severe AR patients with preserved LVEF.
Author Disclosures: J. Ooka: None. H. Tanaka: None. K. Matsumoto: None. H. Takada: None. F. Soga: None. Y. Hatani: None. K. Hatazawa: None. H. Matsuzoe: None. H. Shimoura: None. H. Sano: None. Y. Mochizuki: None. K. Ryo-Koriyama: None. K. Hirata: None.
- © 2016 by American Heart Association, Inc.