Prognostic Value of Left Ventricular End-Systolic Volume Index as a Predictor of Heart Failure Hospitalization in Stable Coronary Artery Disease: Data from the Heart and Soul Study

Abstract

Objective-Left ventricular (LV) end-systolic volume indexed to body surface area (ESVI) is a simple yet powerful echocardiographic marker of LV remodeling that can be measured easily. The prognostic value of ESVI and its merit relative to other markers of LV remodeling in patients with coronary heart disease are unknown.Methods-We examined the association of ESVI with hospitalization for heart failure (HF) and mortality in a prospective study of patients with coronary heart disease.Results-Of the 989 participants, 110 (11%) were hospitalized for HF during 3.6 ± 1.1 years of follow-up. Among participants in the highest ESVI quartile (>25 mL/m 2 ), 67 of 248 (27%) developed HF compared with 8 of 248 (3%) among those in the lowest quartile. The association between ESVI and HF hospitalization persisted after adjustment for potential confounders (hazard ratio 5.0, 95% confidence interval, 1.5-16.9; P = .01).Conclusion-ESVI >25 mL/m 2 is an independent predictor of hospitalization for HF in patients with stable coronary heart disease. KeywordsCoronary artery disease; End-systolic volume index; Heart failure hospitalization; Left ventricular remodeling Coronary heart disease (CHD) is the strongest risk factor for heart failure (HF), and when CHD coexists with HF, patients have increased morbidity and mortality compared with those with either disease alone. 1-4 Therefore, early identification of patients with CHD who are at increased risk for HF is of great importance because it might enable earlier treatment, allow for closer monitoring, and potentially reduce considerable morbidity and mortality.Left ventricular (LV) end-systolic volume (ESV) has been shown to be an important determinant of survival after myocardial infarction (MI). 5,6 A decrease in ESV with angiotensin-converting enzyme inhibitor therapy has been associated with a reduction in cardiac events in patients with moderately decreased LV systolic function. 7 By using left ventriculography, ESV has been shown to be an important predictor of both postoperative LV function and survival after coronary artery bypass grafting in patients with LV systolic dysfunction. 8,9 The aforementioned studies have consistently shown that large increases in ESV predict adverse cardiovascular outcomes in participants with LV systolic dysfunction. NIH Public AccessWith advances in the treatment of CHD, most patients are living longer, and the number of patients at risk of and dying of HF continues to grow. 2,4,10 Current HF guidelines 11 emphasize early identification of patients who are at risk for morbidity and mortality from HF, which is important not only for the prevention of HF and early initiation of therapies for HF but also for the containment of health care costs associated with treating those with advanced HF. Echocardiography has become one of the most commonly used noninvasive modalities for assessment of ventricular volumes and function, 12 and can provide prognostic information for the prediction of future HF events. 13 Although many sophisticated echo...

Effect of Severe Obstructive Sleep Apnea on Morphology of Left-Sided Heart and Pulmonary Artery Pressure

“…It remained significant even after controlling for the body surface area. In non-obese subjects, two factors-male gender and myocardial infarction have been found to be associated with left ventricular end-systolic volume index [25]. In present study, none of the subjects ever had myocardial infarction.…”

Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively

“…15 The role of ESVI by echocardiography as a predictor of CHF hospitalization in stable CAD have been reported in the Heart and Soul Study. 36 In contrast to the adult patient population, echocardiography with or without ERNA has become a standard for evaluation in pediatric patient population, [10][11][12][13][14] where smaller patient size permits effective use of higher frequency transducers, with better image quality and higher spatial resolution, and less acoustic artifact than in adults (Figure 3). The use of contrast represents an important opportunity for further investigation in children and adults treated with chemotherapy, as the American Society of Echocardiography guidelines state the underestimation of cardiac volumes by echocardiography can be nearly resolved when contrast agents are used.…”

Materials for cardiac tissue engineering

“…Interestingly, injectable hydrogels also preserve cardiac function when administrated without cells, demonstrating that the cells may not be responsible [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. For instance, promising preliminary results obtained in rodents and pigs using alginate [45,46] led to the first clinical trials in MI patients (NCT00557531 and NCT01226563) [55].…”