Assessing LV Contractility Identifies Populations With Preserved Ejection Fraction at Risk of Adverse Heart Failure...

Area of Science:

• Cardiology
• Clinical Research
• Biomedical Engineering

Background:

• Left ventricular ejection fraction (LVEF) is a standard heart failure (HF) assessment tool but is limited by load dependence.
• There is a need for additional tools to risk-stratify patients with normal LVEF.
• The cardiac contractility index (CCI), a ratio of systolic blood pressure to left ventricular end-systolic volume, was investigated.

Purpose of the Study:

• To assess the prognostic value of the cardiac contractility index (CCI).
• To evaluate CCI's association with subclinical myocardial dysfunction and incident HF.
• To determine if CCI can risk-stratify patients with normal LVEF.

Main Methods:

• Prospective observational cohort study of newly diagnosed HF patients.
• Analysis of UK Biobank data for associations between CCI, myocardial dysfunction, and incident HF.
• Stratification into HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) groups.

Main Results:

• In HF patients, declining CCI correlated with increased mortality (P<0.001).
• In HFpEF, below-median CCI indicated higher mortality risk (17.3/100 patient-years) compared to above-median CCI (8.8/100 patient-years; P<0.001).
• In individuals without HF and normal LVEF, below-median CCI was linked to a 33% increased risk of incident HF (aHR, 1.33; P=0.043).

Conclusions:

• CCI is a simple, noninvasive, and relatively afterload-independent method for stratifying HF risk, particularly in normal LVEF populations.
• CCI's simplicity allows for application to existing clinical trial data and use in future randomized controlled trials.