Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality

Abstract

Based on our previous observation, inertia stress (IS) of late systolic aortic flow was often observed in left ventricles with relatively higher left ventricular (LV) ejection fraction (EF). Most left ventricles with relatively lower LVEF did not have IS. Accordingly, lack of IS may correlate with LV diastolic dysfunction through the loss of LV elastic recoil and may contribute to the pathogenesis of heart failure (HF) and reduced survival. We enrolled 144 consecutive patients that underwent cardiac catheterization for the diagnosis of coronary artery disease. Left ventricular ejection fraction (LVEF) was obtained from left ventriculography. The IS was calculated from the LV pressure (P)−dP/dt relation. The study endpoint of this retrospective outcome-observational study was combined subsequent acute decompensated heart failure (ADHF) and all-cause mortality. During the follow-up period (median 6.1 years), seven unscheduled hospitalizations for ADHF and nine all-cause deaths were observed. The event-free survival rate was significantly higher among patients with IS than among patients without IS (log-rank, p = 0.001). On a multivariate Cox regression analysis, lack of IS was a prime predictor of the endpoint during follow-up (hazard ratio: 6.98; 95 % confidence interval: 1.48–33.03; p = 0.01). An LVEF ≥ 58 % was a surrogate indicator for the presence of IS, and patients with LVEF ≥ 58 % had fewer incidences of the endpoint than patients with LVEF < 58 %. In conclusion, lack of IS or LVEF < 58 % should be a predictor of future ADHF and all-cause mortality.Electronic supplementary materialThe online version of this article (doi:10.1007/s00380-015-0657-1) contains supplementary material, which is available to authorized users.

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

“…The loss of IFLAF is highly associated with the impairment of LV relaxation because of a lack of elastic recoil at the very early phase of diastole 7, 17, 20. We also demonstrated previously that LVEF < 58% could significantly predict the loss of inertia force in patients with preserved LVEF 8. In addition, several other studies that used Doppler echocardiography or cardiac magnetic resonance have reported the impairment of systolic function in patients with LVEF levels that are much higher than 50% (up to around 60%) of LVEF in patients with preserved LVEF 4, 5, 6, 8.…”

“…Goto et al . reported the importance of IFLAF as a prognostic indicator in patients with preserved LVEF 8. Furthermore, when the tightness of correlation was compared between patients with rlEF and those with rhEF, such a correlation would become significantly lower in the patients with rhEF ( r  = −0.228, P  < 0.001) compared with those with rlEF ( r  = −0.345, P  < 0.001).…”

“…We reported previously that a loss of IFLAF, which was calculated from the LV pressure and dP/dt relationship as derived from LV pressure waves obtained with a catheter‐tipped micromanometer,7 was significantly associated with adverse events in HF among patients with preserved LVEF (LVEF ≥ 50%) 6, 8. The loss of IFLAF is highly associated with the impairment of LV relaxation because of a lack of elastic recoil at the very early phase of diastole 7, 17, 20.…”

“…This is because we found previously that LVEF ≥ 60% was associated with the maintenance of IFLAF in patients with HFpEF. The IFLAF is a notable systolic functional parameter with predictive value for adverse events in HFpEF and is calculated from the LV pressure and the dP/dt relationship 6, 7, 8. One subgroup consisted of patients with HF with relatively high LVEF (LVEF ≥ 60%; the HFrhEF group), and the other subgroup consisted of patients with relatively low LVEF (40% < LVEF < 60%; the HFrlEF group).…”

Nebivolol: An Appealing, Awaited and Nitric Oxide Potentiator Drug for the Treatment of Heart Failure

“…To evaluate pumping function of the left ventricle, ejection fraction is the most common parameter that is measured. 3 Ejection fraction is measured in percentage and refers to the percentage of the blood that leaves the ventricle each time the heart contracts. Ejection fraction is conventionally measured for the left ventricles and this is the reason why in most cases, Ejection Fraction commonly refers to Left Ventricular Ejection Fraction (LVEF).…”