title: The Prognostic Utility of Echo-Estimated Left Ventricular End-Diastolic Pressure-Volume Relationship in Stable Coronary Artery Disease: The Heart and Soul Study.
abstract: BACKGROUND
  While changes in the left ventricular end-diastolic pressure-volume relationship (LV-EDPVR) can be estimated using echocardiography, their prognostic utility in stable coronary artery disease (CAD) is unknown.
  
  
  METHODS
  Using echo-estimated LV end-diastolic volume index and diastolic function category, the relative position of the LV-EDPVR was defined in 901 participants with stable CAD as: (1) left-shifted, (2) right-shifted, or (3) intermediate. We then evaluated the association of LV-EDPVR position relative to the intermediate category with time to hospitalization for heart failure (HF) or cardiovascular (CV) death using Cox proportional hazards models.
  
  
  RESULTS
  During 7.0 ± 3.1 years of follow-up, there were 207 admissions for HF or CV deaths. Both leftward and rightward shifts of LV-EDPVR were associated with a significantly higher risk of HF or CV death (HR 1.73, 95% CI 1.15-2.62 and HR 6.75, 95% CI 4.02-11.31, respectively). In multivariable-adjusted models, these associations were attenuated but remained significant (HR 1.66, 95% CI 1.08-2.55 for left-shifted and HR 4.19, 95% CI 2.32-7.55 for right-shifted). The association of LV-EDPVR with HF or CV death was no longer significant after inclusion of N-terminal pro-brain natriuretic peptide level as a covariate.
  
  
  CONCLUSIONS
  In stable CAD, echo-estimated leftward and rightward shifts in the LV-EDPVR are associated with HF and CV death. The loss of these associations after adjustment for N-terminal pro-brain natriuretic peptide level suggests that echo-estimated LV-EDPVR captures changes in LV filling pressure at any given LV end-diastolic volume.
authors.affiliation: University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Mishra
authors.affiliation: University of California, San Francisco, San Francisco, California.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Tietjens
authors.affiliation: San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Mathilda
authors.initials: M
authors.lastname: Regan
authors.affiliation: University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.affiliation: University of California, San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: coronary artery disease; diastolic function; echocardiography; heart failure; left ventricular end-diastolic pressure