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

• DOI: 10.1007/s00380-015-0657-1
• Publication Date: 2015-03-13T13:31:25Z
• Authors: Toshihiko Goto; Kazuaki Wakami; Hidekatsu Fukuta; Hiroshi Fujita; Tomomitsu Tani; Nobuyuki Ohte
• Keywords: Male; Cardiac Catheterization; Coronary Disease; Kaplan-Meier Estimate; Disease-Free Survival; 03 medical and health sciences; Patient Admission; 0302 clinical medicine; Japan; Risk Factors; Cause of Death; Humans; Aged; Proportional Hazards Models; Retrospective Studies; Heart Failure; Chi-Square Distribution; Incidence; Stroke Volume; Middle Aged; 3. Good health; Multivariate Analysis; Original Article; Female; Cardiology and Cardiovascular Medicine

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.