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Publications

Journal Article Ahead of print

PubMed: 42249823 DOI: 10.1093/eschf/xvag151

Hypercontractile Phenotype at Rest in Chronic Coronary Syndromes Predicts Impaired Functional Reserve and Increased Mortality.

ESC Heart Fail

Authors: Quirino Ciampi, Yi Wang, Lauro Cortigiani, Angela Zagatina, Ratnasari Padang, Garvan C Kane, Hector R Villarraga, Adelaide M Arruda-Olson, Elena Kalinina, Jorge Lowenstein, Rosina Arbucci, Diego M Lowenstein Haber, Sofia Marconi, Jelena Celutkiene, Alla Boshchenko, Tamara Ryabova, Hugo Rodriguez-Zanella, Francesca Bursi, Karina Wierzbowska-Drabik, Jaroslaw D Kasprzak, Elisa Merli, Ana Djordjevic-Dikic, Miguel Amor, Maciej Haberka, Ariel Saad, Ayten Safarova, Tatiana Timofeeva, Jesus Peteiro Vazquez, Fausto Rigo, Aleksandra Nikolic, Miodrag Ostojic, Nicola Gaibazzi, Tamara Kovacevic-Preradovic, Emma Cerracchio, Giovanni Luigi Tripepi, Lixue Yin, Bruno Villari, Mauro Pepi, Scipione Carerj, Patricia A Pellikka, Eugenio Picano

Affiliations

  • Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy.
  • Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People's Hospital, Chengdu, China.
  • Cardiology Department, and Aesculapius Medical Center San Luca Hospital, Lucca, Italy.
  • Cardiosurgery Department, St. Petersburg State University, Saint Petersburg, Russian Federation.
  • Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina.
  • 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.
  • Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation.
  • Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico.
  • Department of Health Sciences, University of Milan, Cardiology Division, ASST Santi Paolo e Carlo, Milan, Italy.
  • Department of Internal Diseases and Clinical Pharmacology, Medical University, Lodz, Poland.
  • I Department of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland.
  • Cardiology Unit, Ospedale per gli Infermi, Faenza, and Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy.
  • Cardiology Clinic, University Center Serbia, Medical School, University Clinical Center Serbia, University of Belgrade, Serbia.
  • Hospital Echocardiography Laboratory, Ramos Mejia Hospital, Buenos Aires, Argentina.
  • University of Silesia, Cardiology Department, Katowice, Poland.
  • División de Cardiología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
  • Department of Internal Medicine with a course in Cardiology and functional Diagnostics at the Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia.
  • CHUAC-Complexo Hospitalario Universitario A Coruna-University of A Coruna, La Coruna, Spain.
  • Villa Salus Foundation/IRCCS San Camillo Hospital, Venice Venezia, Italy.
  • Department of Noninvasive Cardiology, Institute for Cardiovascular Diseases Dedinje, School of Medicine, Belgrade, Serbia.
  • University of Parma, Cardiology Department, Parma, Italy.
  • Clinic of Cardiovascular Diseases, University of Banja Luka University Clinical Centre of the Republic of Srpska.
  • CNR, Institute of Clinical Physiology, Reggio Calabria, Italy.
  • Centro Cardiologico Monzino, IRCCS, Milano, Italy, Past-President SIECVI.
  • Cardiology Division, University Hospital Policlinico G. Martino, University of Messina, Messina, Italy, President SIECVI.

Abstract

BACKGROUND

Transthoracic echocardiography (TTE) identifies a hypercontractile phenotype (HP) in chronic coronary syndromes (CCS), characterized by elevated resting left ventricular (LV) elastance (Force = systolic blood pressure/end-systolic volume).

OBJECTIVES

To evaluate the prognostic significance and functional correlates of HP.

METHODS

In a prospective multicenter study, 10,677 CCS patients underwent resting TTE to assess LV ejection fraction (EF), stroke volume (SV), and force by quantitative volumetric echocardiography. All patients were followed for the endpoint of all-cause mortality. In a subset of 5,834 patients, stress echocardiography (exercise or dobutamine) was performed for LV contractile reserve (LVCR) and heart rate reserve (HRR).

RESULTS

Patients were stratified into Force quintiles (Q1-Q5). HP patients exhibited lower SV at rest (Q5=34.8±12.3 vs. Q1-Q4=57.4 ± 19.1 mL; p<0.01) and higher EF at rest (Q5=64.8±6.9% vs. Q1-Q4= 58.1±8.7%, p<0.01). During a median follow-up of 24 months (interquartile range=12- 40 months), 509 deaths occurred. The exposure-adjusted death rate was lowest in Q3 (3.53-4.51 mmHg/mL; 1.03 per 100 person/years) and higher in Q1 (≤2.62 mmHg/mL, 2.88), Q2 (2.63-3.52 mmHg/mL, 1.86), Q4 (4.52-6.11 mmHg/mL,1.56), and Q5 (HP, >6.11 mmHg/mL; 1.88; p<0.0001 vs. Q1 and Q3). Multivariable analysis identified HP (Q5; HR 1.531 vs Q3, 95% CI 1.116-2.099; p=0.006) and EF (HR 0.963, 95% CI 0.953-0.972; p<0.0001) as independent predictors of death. During exercise or dobutamine stress, HP showed reduced LVCR (ΔEF: Q5 = 4.3± 9.4% vs. Q1-Q4 = 7.0±9.3%; p<0.001) and blunted HRR (Q5 = 1.77± 0.33 vs. Q1-Q4 = 1.85±0.39; p<0.01). All patients with force-based LV contractile reserve >4.1 (present in 185, 3.2% of the population) survived.

CONCLUSIONS

CCS patients with HP assessed by resting TTE demonstrate higher mortality and multilayered functional impairment, including reduced LV contractile and chronotropic reserves. HP improved the prediction of mortality by EF. A "stronger" heart is, in fact, functionally and prognostically weaker.

MeSH

Exercise, Mortality, Heart Failure, Heart, Stress, Physiological, Phenotype, Dobutamine, Echocardiography