Predictors of hypercontractile heart phenotype in patients with chronic coronary syndromes or heart failure
Author:
Wang Yi1, Ciampi Quirino2, Cortigiani Lauro3, Zagatina Angela4, Kasprzak Jaroslaw D.5, Wierzbowska-Drabik Karina5, Haberka Maciej6, Barral Patricia7, Souto Germán7, Djordjevic-Dikic Ana8, Reisenhofer Barbara9, Boshchenko Alla10, Ryabova Tamara10, Rodriguez-Zanella Hugo11, Rigo Fausto12, D'Andrea Antonello13, Gaibazzi Nicola14, Merli Elisa15, Lisi Matteo16, Simova Iana17, Barbieri Andrea18, Morrone Doralisa19, Pitino Annalisa20, De Nes Michele20, Tripepi Giovanni L.20, Yin Lixue1, Citro Rodolfo21, Carerj Scipione22, Pepi Mauro23, Pellikka Patricia A.24, Picano Eugenio8
Affiliation:
1. Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital 2. Fatebenefratelli Hospital 3. San Luca Hospital 4. Research Scientific Cardiocenter “Medika” 5. Medical University 6. SHS, Medical University of Silesia 7. Ramos Mejia Hospital 8. University Center Serbia, University of Belgrade 9. Felice Lotti Hospital 10. Tomsk National Research Medical Centre of the Russian Academy of Sciences 11. Instituto Nacional de Cardiologia Ignacio Chavez 12. Dolo Hospital 13. Umberto I Hospital, Nocera Inferiore (ASL Salerno) 14. Parma University Hospital 15. Ospedale per gli Infermi 16. Ospedale S. Maria delle Croci 17. Medical University Pleven 18. Policlinico University Hospital of Modena, University of Modena and Reggio Emilia 19. University of Pisa 20. CNR, Pisa-Roma-Reggio Calabria 21. University of Molise 22. University of Messina 23. Centro Cardiologico Monzino, IRCCS 24. Mayo Clinic
Abstract
Abstract
Background
Hypercontractile phenotype (HP) of the left ventricle (LV) is an actionable therapeutic target in patients with chronic coronary syndromes (CCS) or heart failure (HF), but its clinical recognition remains difficult.
Objectives
To assess the clinical variables associated with the HP.
Methods
In a prospective, observational, multicenter study, we recruited 5,122 patients (age 65 ± 11 years, 2974 males, 58%) with CCS and/or HF with preserved ejection fraction (EF). Systolic blood pressure (SBP) was measured. We assessed wall motion score index (WMSI), LV end-diastolic volume (EDV), end-systolic volume (ESV), EF, force (SBP/ESV), stroke volume (SV), arterial elastance (SBP/SV), and ventricular-arterial coupling (VAC, as SV/ESV). Univariable and multivariable logistic regression analysis assessed independent factors associated with the highest force sextile.
Results
For all the studied patients, force was 4.51 ± 2.11 mmHg/ml, with the highest sextile (Group 6) > 6.36 mmHg/ml. By multivariable logistic regression model, the highest sextile of force was associated with age > 65 years (OR 1.62, 95% CI 1.36–1.93, p < 0.001), hypertension (OR 1.76, 95% CI 1.40–2.21, p < 0.001), female sex (OR 4.52, 95% CI 3.77–5.42, p < 0.001), absence of beta-blocker therapy (OR 1.41, 95% CI 1.16–1.68), rest SBP ≥ 160 mmHg (OR 2.81, 95% CI 2.21–3.56, p < 0.001), high heart rate (OR 2.08, 95% CI 1.61–2.67, p < 0.001), and absence of prior myocardial infarction (OR 1.34, 95% CI 1.07–1.68, p = 0.012). Patients in the highest sextile of force showed lower values of WMSI, SV, EDV, and ESV, and higher values of arterial elastance and VAC.
Conclusions
HP of the LV with high force was clinically associated with advanced age, female sex, high resting SBP, and the absence of 𝛽-blocker therapy. By transthoracic echocardiography, HP was associated with a small heart with reduced EDV, reduced SV despite high EF, and higher arterial elastance.
Publisher
Research Square Platform LLC
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