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Assessing LV Contractility Identifies Populations With Preserved Ejection Fraction at Risk of Adverse Heart Failure
Sam Straw1, Oliver I Brown1, Charlotte A Cole2
1Leeds Institute of Cardiovascular and Metabolic Medicine (S.S., O.I.B., M.C.-R., M.F.P., M.D., T.A.S., E.L., K.K.W., M.T.K., R.M.C., J.G.), University of Leeds, United Kingdom.
Insights
The cardiac contractility index (CCI) effectively predicts heart failure (HF) risk, even in patients with normal left ventricular ejection fraction (LVEF). This simple, noninvasive measure offers valuable prognostic insights for HF populations.
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.
Background:
Left ventricular ejection fraction (LVEF) is an essential tool for heart failure (HF) assessment but is limited by load dependence. Additional tools are needed to risk-stratify normal LVEF populations. We aimed to assess the prognostic value of systolic blood pressure-indexed left ventricular end-systolic volume ratio, or cardiac contractility index (CCI).
Methods:
In a prospective observational cohort study of people newly diagnosed with HF, we defined characteristics and outcomes associated with LVEF and CCI, including after stratification into HF with reduced ejection fraction or HF with preserved ejection fraction. We used UK Biobank to assess whether CCI is associated with subclinical myocardial dysfunction and incident HF.
Results:
In people with HF, mortality increased over tertiles of declining CCI (P<0.001). Within the HF with preserved ejection fraction group, below-median CCI was associated with distinct clinical characteristics and an all-cause mortality risk approximately twice that of those with above median CCI (observed event rate 17.3/100 patient-years versus 8.8/100 patient-years; P<0.001), similar to those with HF with reduced ejection fraction. Modeled as continuous variables, there was a curvilinear relationship between mortality across the detected range of CCI, while there was no clear association with mortality risk across a wide range of LVEF (20%-55%). In UK Biobank for participants without HF and normal LVEF, below-median CCI was associated with ≈33% increased risk of incident HF (adjusted hazard ratio, 1.33 [1.01-1.75]; P=0.043). Decreasing CCI was also associated with lower myocardial contractility defined using global radial and circumferential strain.
Conclusions:
CCI is a simple, noninvasive, relatively afterload-independent method to stratify HF risk in populations with normal LVEF. Its simplicity means CCI could be applied to existing clinical trial data sets or used be as an inclusion criterion in future randomized controlled trials.
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