Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study
Issued Date
2025-01-01
Resource Type
ISSN
08947317
eISSN
10976795
Scopus ID
2-s2.0-85217974308
Pubmed ID
39818322
Journal Title
Journal of the American Society of Echocardiography
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of the American Society of Echocardiography (2025)
Suggested Citation
Wang Y., Ciampi Q., Cortigiani L., Zagatina A., Padang R., Kane G.C., Villarraga H.R., Vazquez J.P., Kalinina E., Boshchenko A., Ryabova T., Manganelli F., Rodriguez-Zanella H., Celutkiene J., Merli E., Borguezan-Daros C., Lowenstein J., Arbucci R., Lowenstein Haber D.M., Marconi S., Merlo P.M., Wierzbowska-Drabik K., Safarova A., Timofeeva T., Saad A., Bursi F., Kasprzak J.D., Djordjevic-Dikic A., Kobal S., Soulis D., Gaibazzi N., Ratanasit N.C., Citro R., Varga A., Costantino M.F., Rigo F., Nikolic A., Benfari G., Amor M., Camarozano A.C., Cocchia R., Palinkas A., D'Andrea A., Ostojic M., Preradović T.K., Simova I., Re F., Colonna P., D'Alfonso M.G., Mori F., Dodi C., Valente F.X., Tripepi G., Yin L., Pepi M., Carerj S., Pellikka P.A., Picano E. Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study. Journal of the American Society of Echocardiography (2025). doi:10.1016/j.echo.2024.12.012 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/105397
Title
Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study
Author(s)
Wang Y.
Ciampi Q.
Cortigiani L.
Zagatina A.
Padang R.
Kane G.C.
Villarraga H.R.
Vazquez J.P.
Kalinina E.
Boshchenko A.
Ryabova T.
Manganelli F.
Rodriguez-Zanella H.
Celutkiene J.
Merli E.
Borguezan-Daros C.
Lowenstein J.
Arbucci R.
Lowenstein Haber D.M.
Marconi S.
Merlo P.M.
Wierzbowska-Drabik K.
Safarova A.
Timofeeva T.
Saad A.
Bursi F.
Kasprzak J.D.
Djordjevic-Dikic A.
Kobal S.
Soulis D.
Gaibazzi N.
Ratanasit N.C.
Citro R.
Varga A.
Costantino M.F.
Rigo F.
Nikolic A.
Benfari G.
Amor M.
Camarozano A.C.
Cocchia R.
Palinkas A.
D'Andrea A.
Ostojic M.
Preradović T.K.
Simova I.
Re F.
Colonna P.
D'Alfonso M.G.
Mori F.
Dodi C.
Valente F.X.
Tripepi G.
Yin L.
Pepi M.
Carerj S.
Pellikka P.A.
Picano E.
Ciampi Q.
Cortigiani L.
Zagatina A.
Padang R.
Kane G.C.
Villarraga H.R.
Vazquez J.P.
Kalinina E.
Boshchenko A.
Ryabova T.
Manganelli F.
Rodriguez-Zanella H.
Celutkiene J.
Merli E.
Borguezan-Daros C.
Lowenstein J.
Arbucci R.
Lowenstein Haber D.M.
Marconi S.
Merlo P.M.
Wierzbowska-Drabik K.
Safarova A.
Timofeeva T.
Saad A.
Bursi F.
Kasprzak J.D.
Djordjevic-Dikic A.
Kobal S.
Soulis D.
Gaibazzi N.
Ratanasit N.C.
Citro R.
Varga A.
Costantino M.F.
Rigo F.
Nikolic A.
Benfari G.
Amor M.
Camarozano A.C.
Cocchia R.
Palinkas A.
D'Andrea A.
Ostojic M.
Preradović T.K.
Simova I.
Re F.
Colonna P.
D'Alfonso M.G.
Mori F.
Dodi C.
Valente F.X.
Tripepi G.
Yin L.
Pepi M.
Carerj S.
Pellikka P.A.
Picano E.
Author's Affiliation
Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona - OO. RR. Scuola Medica Salernitana
Siriraj Hospital
Cardiology Research lnstitute, Tomsk National Research Medical Center, Russian Academy of Sciences
University of Banja Luka
Ospedale San Camillo
Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
Medical University of Lodz, Bieganski Hospital
Ospedale San Carlo, Potenza
Ospedale per gli Infermi di Faenza
Azienda Ospedaliera S.G. Moscati
IRCCS Centro Cardiologico Monzino
Sichuan Provincial People's Hospital
Institute for Cardiovascular Diseases Dedinje
University of Belgrade
Vilniaus Universitetas
Azienda Ospedaliera Di Rilievo Nazionale Antonio Cardarelli
Soroka University Medical Center
Szegedi Tudományegyetem (SZTE)
Complejo Hospitalario Universitario Juan Canalejo
Università degli Studi di Milano, Facoltà di Medicina e Chirurgia
Azienda Ospedaliera Careggi
Universidade Federal do Parana
RUDN University
Università degli Studi del Molise
Università degli Studi di Messina, Facoltà di Medicina e Chirurgia
Hospital Universitari Vall d'Hebron
Azienda Ospedaliera San Camillo Forlanini
Instituto Nacional de Cardiologia Ignacio Chavez
Istituto di Fisiologia Clinica del CNR
Hospital de Clínicas "José de San Martín"
Medical University of Lodz
Mayo Clinic
Università di Parma
Medical University - Pleven
Hospital J.M. Ramos Mejia, Buenos Aires
Università di Verona Scuola di Medicina e Chirurgia
Research Cardiology Center “Medika”
Medical Diagnostic Center Kosmoiatriki
Hospital São José
San Luca Hospital
Investigaciones Medicas
Fatebenefratelli Hospital
Division of Cardiology
Umberto I Hospital
Elisabeth Hospital
Siriraj Hospital
Cardiology Research lnstitute, Tomsk National Research Medical Center, Russian Academy of Sciences
University of Banja Luka
Ospedale San Camillo
Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
Medical University of Lodz, Bieganski Hospital
Ospedale San Carlo, Potenza
Ospedale per gli Infermi di Faenza
Azienda Ospedaliera S.G. Moscati
IRCCS Centro Cardiologico Monzino
Sichuan Provincial People's Hospital
Institute for Cardiovascular Diseases Dedinje
University of Belgrade
Vilniaus Universitetas
Azienda Ospedaliera Di Rilievo Nazionale Antonio Cardarelli
Soroka University Medical Center
Szegedi Tudományegyetem (SZTE)
Complejo Hospitalario Universitario Juan Canalejo
Università degli Studi di Milano, Facoltà di Medicina e Chirurgia
Azienda Ospedaliera Careggi
Universidade Federal do Parana
RUDN University
Università degli Studi del Molise
Università degli Studi di Messina, Facoltà di Medicina e Chirurgia
Hospital Universitari Vall d'Hebron
Azienda Ospedaliera San Camillo Forlanini
Instituto Nacional de Cardiologia Ignacio Chavez
Istituto di Fisiologia Clinica del CNR
Hospital de Clínicas "José de San Martín"
Medical University of Lodz
Mayo Clinic
Università di Parma
Medical University - Pleven
Hospital J.M. Ramos Mejia, Buenos Aires
Università di Verona Scuola di Medicina e Chirurgia
Research Cardiology Center “Medika”
Medical Diagnostic Center Kosmoiatriki
Hospital São José
San Luca Hospital
Investigaciones Medicas
Fatebenefratelli Hospital
Division of Cardiology
Umberto I Hospital
Elisabeth Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes. Methods: In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction, force (SBP/LVESV), stroke volume (SV), arterial elastance, ventricular-arterial coupling, and left atrial volume index were assessed. Global longitudinal strain was available in 1,164 patients (48.9%). Six hundred eighty patients finished follow-up with a composite endpoint of major adverse cardiac events (MACEs). Patients were divided into three groups: group 1, low force (<25th percentile, <3.24 mm Hg/mL); group 2, intermediate force (≥25th percentile and ≤75th percentile, 3.24-5.48 mm Hg/mL); and group 3, high force (>75th percentile, >5.48 mmHg/mL). Results: The three groups showed a gradient with descending values (group 3 > group 2 > group 1) for SBP, LV ejection fraction, global longitudinal strain, arterial elastance, and ventricular-arterial coupling, with the opposite gradient (group 1 > group 2 > group 3) for LVEDV, LVESV, SV, and left atrial volume index values (P < .01 for all). After a median follow-up period of 16 months, 205 MACEs occurred in 138 patients. The cumulative MACE rate was lowest in group 2 (14.7% person-years) and higher in groups 1 (16.1% person-years) and 3 (22.9% person-years; log-rank P = .036). Conclusions: Patients with HFpEF present with different LV contractile phenotypes, easily identified with resting LV force and volumetric transthoracic echocardiography. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LVEDV and normal SV, while the hypercontractile phenotype is characterized by a small left ventricle with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk for subsequent events.
