title: Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure.
abstract: OBJECTIVE
  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 [V0]); 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.
authors.affiliation: Penn Cardiovascular Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Electronic address: bonnie.ky@uphs.upenn.edu.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.forename: Abigail
authors.initials: A
authors.lastname: May Khan
authors.forename: Ted
authors.initials: T
authors.lastname: Plappert
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.forename: Barry A
authors.initials: BA
authors.lastname: Borlaug
authors.forename: David A
authors.initials: DA
authors.lastname: Kass
authors.forename: Martin
authors.initials: M
authors.lastname: St John Sutton
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Cappola
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology; D009929:Organ Size; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology
keywords: CI; CV; EDV; EF; ESP; ESPVR; ESV; Ea; Ea/Ees(sb); Ees; Ees(sb); HF; HR; IQR; LV; LVOT; N-terminal pro–B-type natriuretic peptide; NT-proBNP; NYHA; New York Heart Association; SV; V(0); V(100); VA; VAD; arterial elastance; coefficient of variation; confidence interval; ejection fraction; end-diastolic volume; end-systolic elastance; end-systolic elastance, single beat; end-systolic pressure volume; end-systolic pressure-volume relationship; end-systolic volume; hazard ratio; heart failure; interquartile range; left ventricular; left ventricular outflow tract; mechanics; stroke volume; ventricular assist device; ventricular volume at an end-systolic pressure of 100 mm Hg; ventricular volume at an end-systolic pressure of 0 mm Hg; ventricular-arterial; ventricular-arterial coupling, single beat