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Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
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Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Published on: April 13, 2015

Hypercontractile phenotype at rest in chronic coronary syndromes predicts impaired functional reserve and increased

Quirino Ciampi1, Yi Wang2, Lauro Cortigiani3

  • 1Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, 12, Benevento I-82100, Italy.

ESC Heart Failure
|June 6, 2026
PubMed

Insights

A hypercontractile phenotype (HP) in chronic coronary syndromes (CCS) indicates higher mortality and impaired function. Despite appearing strong, HP hearts are prognostically weaker, with reduced reserves and increased death risk.

Area of Science:

  • Cardiology
  • Echocardiography
  • Prognostic Studies

Background:

  • Transthoracic echocardiography (TTE) can identify a hypercontractile phenotype (HP) in chronic coronary syndromes (CCS).
  • HP is characterized by elevated resting left ventricular (LV) elastance, calculated as systolic blood pressure divided by end-systolic volume.
  • This phenotype presents a paradox of apparent strength with potential underlying weakness.

Purpose of the Study:

  • To determine the prognostic significance of HP in CCS patients.
  • To investigate the functional correlates of HP, including contractile and heart rate reserves.
  • To assess if HP improves mortality prediction beyond traditional measures like ejection fraction (EF).

Main Methods:

  • A prospective, multicenter study involving 10,677 CCS patients.
  • Resting TTE was used to measure LV ejection fraction (EF), stroke volume (SV), and elastance (force).
  • A subset of 5,834 patients underwent stress echocardiography to assess LV contractile reserve (LVCR) and heart rate reserve (HRR).

Main Results:

  • Patients with HP (highest force quintile) had lower resting stroke volume and higher resting EF.
  • Over a median 24-month follow-up, HP was associated with increased all-cause mortality (HR 1.531 vs. Q3).
  • HP patients demonstrated reduced LV contractile reserve (lower ΔEF) and blunted heart rate reserve during stress testing.

Conclusions:

  • HP in CCS patients identified by resting TTE signifies higher mortality risk.
  • This phenotype is linked to significant functional impairments, including reduced LV contractile and chronotropic reserves.
  • HP provides incremental prognostic value for mortality prediction when combined with EF, challenging the notion of a "stronger" heart being healthier.
Abstract

Keywords:
EchocardiographyElastanceForceOutcomeSurvival

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