The purpose of the study was to determine the prognostic value of ventricular-arterial coupling (VAC) in patients with arterial hypertension (AH) and stable heart failure with reduced ejection fraction (HFrEF).Design and Method:
In prospective study (follow-up 12–24 months, median 18 months) prognosis of 93 stable patients with controlled hypertension and HFrEF was evaluated. Adverse outcomes included all cause death or first HF hospitalization. 2-dimentional echocardiography was used to assess arterial elastance (Ea) and end-systolic LV elastance (Ees). VAC was assessed as the ratio Ea/Ees. Arterial stiffness was assessed using applanation tonometry. Clinical and demographic parameters, parameters of LV function, VAC and arterial stiffness were included in multivariate analysis. P < 0.05 was considered significant.Results:
Adverse outcomes were revealed in 39% of patients (15% deaths, 24% HF hospitalizations). The following factors increased the risk of adverse outcomes: LVEF <25%, index of VAC 33.3, stroke work (SW)/pressure volume area (PVA) (LV work efficiency) <38%, augmentation index (AI) ≥25%, time to reflected wave (Tr) <135. Pulse wave velocity ≥15 m/s, office systolic BP <120 mmHg were associated with increased risk of HF hospitalizations. AI >35%, office systolic BP <120 and diastolic BP <70, Tr <116, SW/PVA <48% were associated with increased risk of all-cause death.Conclusions:
Parameters of VAC and arterial stiffness have independent prognostic value as well as LVEF and BP in patients with AH and HFrEF. Assessment of VAC via Ea/Ees, an additional noninvasively derived metric, can be used for risk stratification of patients with HFrEF.