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The Prognostic Utility of Echo‐Estimated Left Ventricular End‐Diastolic Pressure–Volume Relationship in Stable Coronary Artery Disease: The Heart and Soul Study
Author(s) -
Mishra Rakesh K.,
Tietjens Jeremy,
Regan Mathilda,
Whooley Mary A.,
Schiller Nelson B.
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12955
Subject(s) - cardiology , medicine , coronary artery disease , heart failure , proportional hazards model , stroke volume , diastole , brain natriuretic peptide , natriuretic peptide , blood pressure , ejection fraction
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.