Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes. Methods: In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction, force (SBP/LVESV), stroke volume (SV), arterial elastance, ventricular-arterial coupling, and left atrial volume index were assessed. Global longitudinal strain was available in 1,164 patients (48.9%). Six hundred eighty patients finished follow-up with a composite endpoint of major adverse cardiac events (MACEs). Patients were divided into three groups: group 1, low force (<25th percentile, <3.24 mm Hg/mL); group 2, intermediate force (≥25th percentile and ≤75th percentile, 3.24-5.48 mm Hg/mL); and group 3, high force (>75th percentile, >5.48 mmHg/mL). Results: The three groups showed a gradient with descending values (group 3 > group 2 > group 1) for SBP, LV ejection fraction, global longitudinal strain, arterial elastance, and ventricular-arterial coupling, with the opposite gradient (group 1 > group 2 > group 3) for LVEDV, LVESV, SV, and left atrial volume index values (P < .01 for all). After a median follow-up period of 16 months, 205 MACEs occurred in 138 patients. The cumulative MACE rate was lowest in group 2 (14.7% person-years) and higher in groups 1 (16.1% person-years) and 3 (22.9% person-years; log-rank P = .036). Conclusions: Patients with HFpEF present with different LV contractile phenotypes, easily identified with resting LV force and volumetric transthoracic echocardiography. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LVEDV and normal SV, while the hypercontractile phenotype is characterized by a small left ventricle with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk for subsequent events. © 2025 American Society of Echocardiography

Авторы
Wang Y. , Ciampi Q. , Cortigiani L. , Zagatina A. , Padang R. , Kane G.C. , Villarraga H.R. , Vazquez J.P. , Kalinina E. , Boshchenko A. , Ryabova T. , Manganelli F. , Rodriguez-Zanella H. , Celutkiene J. , Merli E. , Borguezan-Daros C. , Lowenstein J. , Arbucci R. , Lowenstein Haber D.M. , Marconi S. , Merlo P.M. , Wierzbowska-Drabik K. , Safarova A. , Timofeeva T. , Saad A. , Bursi F. , Kasprzak J.D. , Djordjevic-Dikic A. , Kobal S. , Soulis D. , Gaibazzi N. , Ratanasit N.C. , Citro R. , Varga A. , Costantino M.F. , Rigo F. , Nikolic A. , Benfari G. , Amor M. , Camarozano A.C. , Cocchia R. , Palinkas A. , D'andrea A. , Ostojic M. , Preradović T.K. , Simova I. , Re F. , Colonna P. , D'alfonso M.G. , Mori F. , Dodi C. , Valente F.X. , Tripepi G. , Yin L. , Pepi M. , Carerj S. , Pellikka P.A. , Picano E.
Journal
Journal of the American Society of Echocardiography
Издательство
Elsevier Inc.
Язык
English
Статус
Published
Ссылка
Внешняя ссылка
DOI
10.1016/J.ECHO.2024.12.012
Год
2025
Организации
  • 1 Department of Cardiovascular Ultrasound and Noninvasive Cardiology, Sichuan Provincial People's Hospital, Chengdu, China
  • 2 Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
  • 3 Cardiology Department, San Luca Hospital, Lucca, Italy
  • 4 Cardiology Department, Research Cardiology Center “Medika”, Saint Petersburg, Russian Federation
  • 5 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
  • 6 Complexo Hospitalario Universitario A Coruna, University of A Coruna, La Coruna, Spain
  • 7 Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
  • 8 Cardiology Division, Ospedale Moscati Avellino, Avellino, Italy
  • 9 Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
  • 10 Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, State Research Institute Center for Innovative Medicine, Vilnius, Lithuania
  • 11 Cardiology Unit, Ospedale per gli Infermi, Faenza, Italy
  • 12 Cardiology Division, Hospital San José, Criciuma, Brazil
  • 13 Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
  • 14 Department of Internal Diseases and Clinical Pharmacology, Medical University, Lodz, Poland
  • 15 Department of Internal Medicine With a Course in Cardiology and Functional Diagnostics at the Medical Institute of the People's Friendship University of Russia, Moscow, Russian Federation
  • 16 División de Cardiología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
  • 17 Cardiology Division, Department of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
  • 18 I Department of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
  • 19 Cardiology Clinic, University Center Serbia, Medical School, University Clinical Center Serbia, University of Belgrade, Belgrade, Serbia
  • 20 Cardiology Department, Soroka University Medical Center, Beer Sheva, Israel
  • 21 Kosmoiatriki Medical Center, Athens, Greece
  • 22 Cardiology Department, University of Parma, Parma, Italy
  • 23 Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 24 Cardiology Department and Echocardiography Lab, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Salerno, Italy
  • 25 Department of Medicine and Health Science, Cardiology Institute Research Responsible University Hospital, University of Molise, Campobasso, Italy
  • 26 Institute of Family Medicine, University of Szeged, Szeged, Hungary
  • 27 Cardiology Division, San Carlo Hospital, Potenza, Italy
  • 28 Villa Salus Foundation/IRCCS San Camillo Hospital, Venice, Italy
  • 29 Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade, Serbia
  • 30 Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
  • 31 Hospital Echocardiography Laboratory, Ramos Mejia Hospital, Buenos Aires, Argentina
  • 32 Hospital de Clinicas UFPR, Medicine Department, Federal University of Paranà, Curitiba, Brazil
  • 33 Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy
  • 34 Internal Medicine Department, Elisabeth Hospital, Hódmezővásárhely, Hungary
  • 35 Department of Cardiology, Umberto I Hospital, Nocera Inferiore, Italy
  • 36 Clinic of Cardiovascular Diseases, University of Banja Luka University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
  • 37 Heart and Brain Center of Excellence, University Hospital, Pleven, Bulgaria
  • 38 Ospedale San Camillo, Cardiology Division, Rome, Italy
  • 39 Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
  • 40 Cardiology Department, Careggi University Hospital, Florence, Italy
  • 41 Cardiology Division, San Antonino Clinic, Piacenza, Italy
  • 42 Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
  • 43 CNR, Institute of Clinical Physiology, Reggio Calabria, Italy
  • 44 Centro Cardiologico Monzino, IRCCS, Milan, Italy
  • 45 Cardiology Division, University Hospital Policlinico G. Martino, University of Messina, Messina, Italy
Ключевые слова
Contractility; Echocardiography; Heart failure with preserved ejection fraction; Left ventricular; Phenotype
Цитировать
ГОСТ MLA RIS BibTex
Поделиться

Другие записи