1. The Prognostic Utility of Echo-Estimated Left Ventricular End-Diastolic Pressure-Volume Relationship in Stable Coronary Artery Disease: The Heart and Soul Study.
- Author
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Mishra, Rakesh K., Tietjens, Jeremy, Regan, Mathilda, Whooley, Mary A., and Schiller, Nelson B.
- Subjects
CORONARY disease ,HEART failure risk factors ,VETERANS' hospitals ,DOPPLER ultrasonography ,BLOOD pressure ,CHI-squared test ,CONFIDENCE intervals ,ECHOCARDIOGRAPHY ,HEALTH status indicators ,LEFT heart ventricle ,HEART physiology ,LONGITUDINAL method ,MEDICAL cooperation ,PEPTIDE hormones ,PROBABILITY theory ,RESEARCH ,STATISTICAL hypothesis testing ,MATHEMATICAL variables ,PILOT projects ,MULTIPLE regression analysis ,PROPORTIONAL hazards models ,DATA analysis software ,DESCRIPTIVE statistics ,KAPLAN-Meier estimator ,BLOOD volume determination ,ODDS ratio ,PROGNOSIS - Abstract
Background While changes in the left ventricular end-diastolic pressure-volume relationship ( LV- EDPVR) can be estimated using echocardiography, their prognostic utility in stable coronary artery disease ( CAD) is unknown. Methods Using echo-estimated LV end-diastolic volume index and diastolic function category, the relative position of the LV- EDPVR was defined in 901 participants with stable CAD as: (1) left-shifted, (2) right-shifted, or (3) intermediate. We then evaluated the association of LV- EDPVR position relative to the intermediate category with time to hospitalization for heart failure ( HF) or cardiovascular ( CV) death using Cox proportional hazards models. Results During 7.0 ± 3.1 years of follow-up, there were 207 admissions for HF or CV deaths. Both leftward and rightward shifts of LV- EDPVR were associated with a significantly higher risk of HF or CV death ( HR 1.73, 95% CI 1.15-2.62 and HR 6.75, 95% CI 4.02-11.31, respectively). In multivariable-adjusted models, these associations were attenuated but remained significant ( HR 1.66, 95% CI 1.08-2.55 for left-shifted and HR 4.19, 95% CI 2.32-7.55 for right-shifted). The association of LV- EDPVR with HF or CV death was no longer significant after inclusion of N-terminal pro-brain natriuretic peptide level as a covariate. Conclusions In stable CAD, echo-estimated leftward and rightward shifts in the LV- EDPVR are associated with HF and CV death. The loss of these associations after adjustment for N-terminal pro-brain natriuretic peptide level suggests that echo-estimated LV- EDPVR captures changes in LV filling pressure at any given LV end-diastolic volume. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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