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

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. © 2025 Elsevier B.V., All rights reserved.

Авторы
Wang Yi 1 , Ciampi Quirino 2 , Cortigiani Lauro 3 , Zagatina Angela V. 4 , Padang Ratnasari 5 , Kane Garvan Christopher 5 , Villarraga Hector Ricardo 5 , Vázquez Jesús Peteiro 6 , Kalinina Elena S. 4 , Boshchenko Alla A. 7 , Ryabova Tamara R. 7 , Manganelli Fiore 8 , Rodríguez-Zanella Hugo Gerardo 9 , Čelutkiene Jelena 10 , Merli Elisa 11 , Borguezan-Daros Clarissa 12 , Lowenstein Jorge A. 13 , Arbucci Rosina 13 , Lowenstein Haber Diego M. 13 , Marconi Sofia 13 , Merlo Pablo Martin 13 , Wierzbowska-Drabik Karina A. 14 , Safarova Ayten Fuadovna 15 , Timofeeva Tatiana M. 15 , Saad Ariel Karim 16 , Bursi Francesca 17 , Kasprzak Jarosław Damian 18 , Djordjevic-Dikic Ana D. 19 , Kobal Sergio L. 20 , Soulis Dimitrios 21 , Gaibazzi Nicola 22 , Ratanasit Nithima Chaowalit 23 , Citro R. 24, 25 , Varga Albert 26 , Costantino Marco Fabio 27 , Rigo Fausto 28 , Nikolić Aleksandra Tomislav 29 , Benfari Giovanni 30 , Amor Miguel 31 , Camarozano Ana Cristina 32 , Cocchia Rosangela 33 , Pálinkás Attila 34 , D'andrea Antonello 35 , Ostojić Miodrag Caslav 36 , Kovačević-Preradović Tamara 36 , Simova Iana Ivaylova 37 , Re Federica 38 , Colonna Paolo 39 , D'alfonso Maria Grazia 40 , Mori Fabio 40 , Dodi Claudio 41 , Valente Filipa Xavier 42 , Tripepi Giovanni Luigi 43 , Yin Lixue 1 , Pepi Mauro 44 , Carerj Scipione 45 , Pellikka Patricia A. 5 , Picano Eugenio 19
Journal
Journal of the American Society of Echocardiography
Издательство
Elsevier Inc.
Номер выпуска
5
Язык
English
Страницы
409-420
Статус
Published
Ссылка
Внешняя ссылка
DOI
10.1016/J.ECHO.2024.12.012
Том
38
Год
2025
Организации
  • 1 Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People's Hospital, Chengdu, China
  • 2 Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
  • 3 Department of Cardiology, San Luca Hospital, Lucca, Italy
  • 4 Department of Cardiology, Research Cardiology Center “Medika”, Saint Petersburg, Russian Federation
  • 5 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, United States
  • 6 Complejo Hospitalario Universitario Juan Canalejo, Corunna, Spain
  • 7 Cardiology Research lnstitute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
  • 8 Division of Cardiology, Azienda Ospedaliera S.G. Moscati, Avellino, Italy
  • 9 Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Mexico
  • 10 Clinic of Cardiac and Vascular Diseases, Vilniaus Universitetas, Vilnius, Lithuania
  • 11 Cardiology Unit, Ospedale per gli Infermi di Faenza, Faenza, Italy
  • 12 Division of Cardiology, Hospital São José, Criciuma, Brazil
  • 13 Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
  • 14 Uniwersytet Medyczny w Lodzi, Lodz, Poland
  • 15 RUDN University, Moscow, Russian Federation
  • 16 Division of Cardiology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
  • 17 Division of Cardiology, Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Milan, Italy
  • 18 Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Lodz, Poland
  • 19 Cardiology Clinic, University of Belgrade, Belgrade, Serbia
  • 20 Department of Cardiology, Soroka University Medical Center, Beer-Sheva, Israel
  • 21 Kosmoiatriki Medical Center, Athens, Greece
  • 22 Department of Cardiology, Università di Parma, Parma, Italy
  • 23 Department of Medicine, Siriraj Hospital, Bangkok, Thailand
  • 24 Cardiology Department and Echocardiography Lab, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona - OO. RR. Scuola Medica Salernitana, Salerno, Italy
  • 25 Department of Medicine and Health Sciences, Università degli Studi del Molise, Campobasso, Italy
  • 26 Department of Family Medicine, Szegedi Tudományegyetem (SZTE), Szeged, Hungary
  • 27 Division of Cardiology, Ospedale San Carlo, Potenza, Potenza, Italy
  • 28 Ospedale San Camillo, Venice, Italy
  • 29 Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
  • 30 Section of Cardiology, Università di Verona Scuola di Medicina e Chirurgia, Verona, Italy
  • 31 Hospital Echocardiography Laboratory, Hospital J.M. Ramos Mejia, Buenos Aires, Buenos Aires, Argentina
  • 32 Department of Medicine, Universidade Federal do Parana, Curitiba, Brazil
  • 33 Azienda Ospedaliera Di Rilievo Nazionale Antonio Cardarelli, Naples, Italy
  • 34 Department of Internal Medicine, Elisabeth Hospital, Hodmezovasarhely, Hungary
  • 35 Department of Cardiology, Umberto I Hospital, Nocera Inferiore, Italy
  • 36 Clinic of Cardiovascular Diseases, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
  • 37 Heart and Brain Center of Excellence, Medical University - Pleven, Pleven, Bulgaria
  • 38 Division of Cardiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
  • 39 Cardiology Hospital, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
  • 40 Department of Cardiology, Azienda Ospedaliera Careggi, Florence, Italy
  • 41 Division of Cardiology, Piacenza, Italy
  • 42 Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • 43 Istituto di Fisiologia Clinica del CNR, Pisa, Italy
  • 44 IRCCS Centro Cardiologico Monzino, Milan, Italy
  • 45 Division of Cardiology, Università degli Studi di Messina, Facoltà di Medicina e Chirurgia, Messina, Italy
Ключевые слова
Contractility; Echocardiography; Heart failure with preserved ejection fraction; Left ventricular; Phenotype
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