Comparative prognostic value of non-invasive ventricular-arterial coupling metrics in the general population

Impaired ventricular-arterial coupling (VAC) is associated with adverse health outcomes. However, the predictive values of VAC calculated by different non-invasive methods remain uncertain. We aimed to assess prognostic values of VAC calculated as the ratio between arterial elastance (Ea) and left ventricular end-systolic elastance (Ees) and between carotid-femoral pulse wave velocity (PWV) and global longitudinal strain (GLS). In 3634 Atherosclerosis Risk In Communities study participants (57.4% women; mean age, 75.1 years), Cox proportional hazard models were constructed to determine associations of VAC metrics with heart failure (HF) and all-cause mortality. Risk prediction models were employed to examine prediction improvement of VAC beyond established risk factors. Over approximately 6.3 years (median), 316 participants experienced HF, and 482 died. The hazard ratios of HF related to 1-SD increment in VAC metrics were 1.28 (95% CI, 1.18-1.38; P < 0.001) for Ea/Ees and 1.40 (1.27-1.54; P < 0.001) for PWV/GLS with adjustments applied for potential confounders. PWV/GLS was the only VAC parameter associated with mortality (adjusted HR, 1.18; 1.08-1.28; P < 0.001). PWV/GLS was observed to have stronger associations with all outcomes in individuals aged ≤74 years than those aged >74 years (P for interaction ≤0.034). The addition of VAC maker to the conventional risk factors improved risk prediction for incident HF (P ≤ 0.010) assessed by C statistics, net reclassification improvement, and integrated discrimination improvement for Ea/Ees (0.702, 22.4%, and 1.40%) and for PWV/GLS (0.701, 22.1%, and 1.46%). In the general population, impaired VAC was associated with a higher risk of incident HF and total mortality.