Prognostic impact of ventricular arterial coupling in asymptomatic patients for heart failure

Background: Cardiac Function and Arterial System interaction is defined as Ventriculo-Arterial (VA) Coupling, expressed as the ratio between Arterial Elastance (EA) and Left Ventricular (LV) End-systolic Elastance (EES). Purpose: To determine, in a large sample of asymptomatic patients with Heart Failure (HF, Stage A), the incremental prognostic value of VA coupling respective to systolic and diastolic dysfunction. Methods: We enrolled 580 patients from a large multicenter survey on asymptomatic HF patients. Evaluation included a complete physical exam, with detailed history, ECG and standard Echocardiography. VA coupling has been measured as EA/EES, where EA=ESP/SV (the ratio of End Systolic pressure-Systolic Arterial Pressure * 0.9- to 2D-Echo Stroke Volume, SV) and EES=ESP/ESV (the ratio of End Systolic pressure to End-systolic Volume, ESV); normal values were between 0.3 and 1.3, as previously described. Primary events at follow up (5 years) included cardiac death, pulmonary oedema, acute myocardial infarction, coronary revascularizations, stroke or transient ischemic attack. Results: Of 580 patients (age 55.4±14 years), 307 were male (52.9%). On average, patients presented a high cardio-vascular risk profile (Smokers 27.1%; Family History of Cardio-vascular disease 41.2%; Diabetes 13%; Arterial Hypertension 63.6%; Dyslipidemia 37.2%; Overweight/Obesity 24.3%). Ejection Fraction (EF) was 62.4±0.9%. Patients presented a variable degree of diastolic dysfunction (32%). Prevalence of Systolic dysfunction (EF <50%) was 10.3%. In patients with impaired VA Coupling we observed an higher prevalence of primary events (18.9%) respective to patients (4.2%) with normal value (RR 5.2; CI 95% 2.1– 13.2; p<0.001). In multivariate analysis VA coupling was predictive for primary events, also after correction for EF, gender, age and diastolic dysfunction (see table). Moreover, VA coupling added a significantly incremental prognostic value (Global Chi-Square increased from 29 to 35; p<0.001) to systolic/diastolic dysfunction, age and gender (see figure)