Abstract
Background Left ventricular (LV) ejection fraction (EF) and LV volumes were reported to have prognostic efficacy in cardiac diseases. In particular, the end-systolic volume index (LVESVI) has been featured as the most reliable prognostic indicator. However, such efficacy in patients with LVEF ≥ 50% has not been elucidated. Methods We screened the patients who received cardiac catheterization to evaluate coronary artery disease concomitantly with both left ventriculography and LV pressure recording using a catheter-tipped micromanometer and finally enrolled 355 patients with LVEF ≥ 50% and no history of heart failure (HF) after exclusion of the patients with severe coronary artery stenosis requiring early revascularization. Cardiovascular death or hospitalization for HF was defined as adverse events. The prognostic value of LVESVI was investigated using a Cox proportional hazards model. Results A univariable analysis demonstrated that age, log BNP level, tau, peak − dP/dt, LVEF, LV end-diastolic volume index (LVEDVI), and LVESVI were associated with adverse events. A correlation analysis revealed that LVESVI was significantly associated with log BNP level (r = 0.356, p < 0.001), +dP/dt (r = −0.324, p < 0.001), −dP/dt (r = 0.391, p < 0.001), and tau (r = 0.337, p < 0.001). Multivariable analysis with a stepwise procedure using the variables with statistical significance in the univariable analysis revealed that aging, an increase in BNP level, and enlargement of LVESVI were significant prognostic indicators (age: HR: 1.071, 95% CI: 1.009–1.137, p=0.024; log BNP : HR : 1.533, 95% CI: 1.090–2.156, p=0.014; LVESVI : HR : 1.051, 95% CI: 1.011–1.093, p=0.013, respectively). According to the receiver-operating characteristic curve analysis for adverse events, log BNP level of 3.23 pg/ml (BNP level: 25.3 pg/ml) and an LVESVI of 24.1 ml/m2 were optimal cutoff values (BNP : AUC : 0.753, p < 0.001, LVESVI : AUC : 0.729, p < 0.001, respectively). Conclusion In patients with LVEF ≥ 50%, an increased LVESVI is related to the adverse events. LV contractile performance even in the range of preserved LVEF should be considered as a role of a prognostic indicator.
Highlights
Left ventricular (LV) ejection fraction (EF) and LV enddiastolic and end-systolic volumes (LVEDV and LVESV, respectively) are commonly used as clinical parameters reflecting global LV systolic performance or LV remodeling [1, 2]
Gilbert and Glantz [9] previously showed that a relatively smaller LV chamber in end-systole, which stored elastic energy during systole, could produce a greater degree of LV recoil force during the isovolumic relaxation and resulted in better LV relaxation. erefore, we Cardiology Research and Practice hypothesized that even in patients with LVEF ≥ 50%, slightly impaired LV systolic function, which is sensitively reflected in an increase in LVESVI, and subsequent prolonged LV relaxation were common mechanisms associated with cardiac death and heart failure (HF)
36.3% of patients had diabetes mellitus as comorbidity. e mean value of LVEF was 68.7% and the median BNP level was in the normal range (15.6 pg/ml; interquartile range (IQR): 8.1 and 36.3 pg/ml)
Summary
Left ventricular (LV) ejection fraction (EF) and LV enddiastolic and end-systolic volumes (LVEDV and LVESV, respectively) are commonly used as clinical parameters reflecting global LV systolic performance or LV remodeling [1, 2]. Left ventricular (LV) ejection fraction (EF) and LV volumes were reported to have prognostic efficacy in cardiac diseases. The end-systolic volume index (LVESVI) has been featured as the most reliable prognostic indicator. Such efficacy in patients with LVEF ≥ 50% has not been elucidated. A univariable analysis demonstrated that age, log BNP level, tau, peak − dP/dt, LVEF, LV end-diastolic volume index (LVEDVI), and LVESVI were associated with adverse events. LV contractile performance even in the range of preserved LVEF should be considered as a role of a prognostic indicator
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