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Predictors of hypercontractile heart phenotype in patients with chronic coronary syndromes or heart failure

Yi Wang1, Quirino Ciampi2, Lauro Cortigiani3

  • 1Department of Cardiovascular Ultrasound and Non-Invasive Cardiology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China.

The International Journal of Cardiovascular Imaging
|October 10, 2024
PubMed

Insights

Hypercontractile phenotype (HP) of the left ventricle is linked to older age, female sex, and high blood pressure. Recognizing HP is key for treating heart conditions like chronic coronary syndromes and heart failure.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology

Background:

  • The hypercontractile phenotype (HP) of the left ventricle (LV) is a significant therapeutic target in patients with chronic coronary syndromes (CCS) or heart failure (HF).
  • Clinical recognition of HP remains challenging, necessitating identification of associated clinical variables.

Purpose of the Study:

  • To identify clinical variables associated with the hypercontractile phenotype (HP) of the left ventricle (LV).

Main Methods:

  • A prospective, observational, multicenter study involving 5122 patients with CCS and/or HF with preserved ejection fraction (EF).
  • Assessment of systolic blood pressure (SBP), wall motion score index (WMSI), LV volumes (EDV, ESV), EF, force (SBP/ESV), stroke volume (SV), arterial elastance (SBP/SV), and ventricular-arterial coupling (VAC).
  • Univariable and multivariable logistic regression analysis to determine factors associated with the highest force sextile.

Main Results:

  • The highest force sextile was significantly associated with advanced age (>65 years), hypertension, female sex, absence of beta-blocker therapy, high resting SBP (≥160 mmHg), high heart rate, and absence of prior myocardial infarction.
  • Patients in the highest force sextile exhibited lower WMSI, SV, EDV, and ESV, alongside higher arterial elastance and VAC.
  • Echocardiographic findings in HP included a small LV with reduced EDV and SV, despite a high EF, and elevated arterial elastance.

Conclusions:

  • The hypercontractile phenotype (HP) of the left ventricle is clinically associated with specific patient characteristics, including advanced age, female sex, high resting systolic blood pressure, and lack of beta-blocker therapy.
  • HP is characterized by reduced LV volumes and stroke volume despite preserved ejection fraction, coupled with increased arterial elastance.
  • These findings aid in the clinical recognition and potential therapeutic targeting of HP in cardiovascular disease management.

Keywords:
EchocardiographyHyperfunctionLeft ventriclePhenotypeSystolic function

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