ESC Heart Fail. 2022;9(2):1228-1238.

Feasibility of the contraction-relaxation coupling index in outcome prediction for patients with acute heart failure.

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제1저자 박지석 · 교신저자 조구영

PMID 34981649 PMC8934974 DOI 10.1002/ehf2.13797 IF 3.8 순환기내과

소속 (4)

Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumi-ro 173beon-gil, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul, 03080, South Korea.
Department of Cardiology, Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.

Abstract

AIMS Contemporary heart failure (HF) classification based on left ventricular (LV) ejection fraction is limited for comprehensive assessment of LV function. We aimed to validate the feasibility of the contraction-relaxation coupling index (CRC) as a novel predictor for clinical outcomes in patients with acute HF.

METHODS AND RESULTS A total of 3266 consecutive patients (median age: 74 years, 53% male) with acute HF were included. CRC was defined as the ratio of end-diastolic elastance (LV end-diastolic pressure/stroke volume) to end-systolic elastance (LV end-systolic pressure/end-systolic volume). The risk for 1 year composite endpoint of all-cause mortality or hospitalization for HF (primary outcome) was compared after group categorization using CRC tertiles (Tertile 1: CRC ≤ 0.17, Tertile 2: 0.17 < CRC ≤ 0.40, and Tertile 3: 0.40 < CRC). The median CRC was 0.3 and the median LVEF was 42%. After adjustment for clinical and echocardiographic covariates, CRC was an independent predictor for the primary outcome (hazard ratio [HR]: 1.74, 95% confidence interval [CI]: 1.47-2.07 in Tertile 3 and HR: 1.21, 95% CI: 1.02-1.44 in Tertile 2 when compared with Tertile 1; HR: 1.23, 95% CI: 1.14-1.33 per one-standard deviation increment in CRC). The risk model with CRC showed better performance in outcome discrimination than the model with LVEF (c-statistic 0.701 vs. 0.699, P for difference <0.001). Patients with higher CRC demonstrated better effectiveness of neurohormonal blockade for the primary outcome compared with those with lower CRC (HR: 0.38, 95% CI: 0.29-0.50 in Tertile 3 and HR: 0.67, 95% CI: 0.52-0.89 in Tertile 1).

CONCLUSIONS CRC provides an independent value for outcome prediction in patients with acute HF. CRC would be a sensitive indicator for prognostic risk stratification and for predicting treatment response to the neurohormonal blockade.

Keywords

Acute heart failureElastanceEnd-diastolic pressure-volume relationshipEnd-systolic pressure-volume relationshipLeft ventricular ejection fraction

Figures

**Figure 1** Definition of the contraction–relaxation coupling index. The diagram represents the left ventricular (LV) single‐beat pressure–volume loop. The contraction–relaxation coupling index (CRC) was defined as the ratio of LV Eed to LV Ees. The detailed calculation of CRC is described in the Methods section. EDPVR, end‐diastolic pressure–volume relationship; ESPVR, end‐systolic pressure–volume relationship; Ped, end‐diastolic pressure; Pes, end‐systolic pressure; SV, stroke volume; SW, stroke work; Ved, end‐diastolic volume; Ves, end‐systolic volume.

**Figure 2** Scatterplot for distribution of patients by Ees and Eed. Patients were labelled according to their heart failure phenotypes. The solid lines represent the cut‐off values of the contraction–relaxation coupling index (CRC) tertiles. Considerable overlap was observed among the three heart failure types across the cut‐offs, especially in Tertile 2. HF, heart failure.

**Figure 3** Kaplan–Meier curve for 1 year composite endpoint according to the contraction–relaxation coupling index (CRC) tertiles. A significant difference was observed in the event‐free rate among the CRC tertiles during the follow‐up period. After adjustment for covariates, Tertile 3 showed the highest risk of the primary outcome. CI, confidence interval.

**Figure 4** Spline curves for estimated risk of the primary outcome according to contraction–relaxation coupling index (CRC). The spline curves represent the estimated hazard ratios (HRs) (blue solid line) and 95% confidence band (blue shade) for the primary outcome across the CRC range in the overall study population (A) and after stratification by medical treatment including RAS inhibitors (B), beta‐blockers (C), and diuretics (D). The spline curves with confidence bands in patients without medical treatment are presented with grey dotted lines. HRs were estimated using the median CRC as a reference with adjustment for covariates.

그림 출처: PubMed Central 공개 논문 (PMC8934974)

Conflict of interest statement

None declared.

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