Prognostic value of ventricular-arterial coupling in patients with arterial hypertension and stable heart failure with reduced ejection fraction

The purpose of the study was to determine the prognostic value of ventricular-arterial coupling (VAC) in patients with arterial hypertension and stable heart failure with reduced ejection fraction (HFrEF). Methods: In prospective study (follow-up 12-24 months, median 18 months) prognosis of 93 stable patients (75% male, age 64 9 years (M SD), history of myocardial infarction 67%, diabetes mellitus 32%, heart rate 75 13/min) with controlled hypertension (blood pressure (BP) <160/100 mmHg, 131 14/80 10 mmHg), symptoms and signs of HF, left ventricular (LV) EF 100 pg/ml (650 679 pg/ml), II/III NYHA class 25/75% was evaluated. Adverse outcomes included all cause death or first HF hospitalization. 2-dimentional echocardiography was used to assess arterial elastance (Ea) and end-systolic LV elastance (Ees). VAC was assessed as the ratio Ea/Ees. Arterial stiffness was assessed using applanation tonometry. Clinical and demographic parameters, parameters of LV function, VAC and arterial stiffness were included in multivariate analysis. P<0.05 was considered significant. Results: Adverse outcomes were revealed in 39% of patients (15% deaths, 24% HF hospitalizations). The following factors increased the risk of adverse outcomes: LVEF <25% (odds ratio (OR) 26.1, 95% confidential interval (CI) 24.9-27.3), index of VAC 3.3 (OR 23.3, 95% CI 22.124.5), stroke work (SW)/pressure volume area (PVA) (LV work efficiency) <38% (OR 8.2, 95% CI 7.0-9.4), augmentation index (AI) 25% (OR 2.3, 95% CI 1.3-3.2), time to reflected wave (Tr) <135 ms (OR 2.1, 95% CI 1.2-3.0). Pulse wave velocity 15 m/s (OR 5.4, 95% CI 3.7-7.1), office systolic BP <120 mmHg (OR 5.1, 95% CI 4.2-6.0) were associated with increased risk of HF hospitalizations. AI 35% (OR 7.3, 95% CI 5.9-8.6), office systolic BP <120 mmHg (OR 3.4, 95% CI 1.3-5.5) and diastolic BP <70 mmHg (OR 3.4, 95% CI 1.3-5.5), Tr <116 ms (OR 2.3, 95% CI 1.1-3.5), SW/PVA <48% (OR 2.3, 95% CI 1.1-3.5) were associated with increased risk of all-cause death. Conclusions: Parameters of VAC, LV work efficiency and arterial stiffness have independent prognostic value as well as LVEF and BP in patients with arterial hypertension and HFrEF. Assessment of VAC via Ea/Ees, an additional noninvasively derived metric, can be used for risk stratification of patients with HFrEF.