| Authors |
Ciampi, Quirino ; Wang, Yi ; Cortigiani, Lauro ; Zagatina, Angela ; Padang, Ratnasari ; Kane, Garvan C ; Villarraga, Hector R ; Arruda-Olson, Adelaide M ; Kalinina, Elena ; Lowenstein, Jorge ; Arbucci, Rosina ; Lowenstein Haber, Diego M ; Marconi, Sofia ; Čelutkienė, Jelena ; Boshchenko, Alla ; Ryabova, Tamara ; Rodriguez-Zanella, Hugo ; Bursi, Francesca ; Wierzbowska-Drabik, Karina ; Kasprzak, Jaroslaw D ; Merli, Elisa ; Djordjevic-Dikic, Ana ; Amor, Miguel ; Haberka, Maciej ; Saad, Ariel ; Safarova, Ayten ; Timofeeva, Tatiana ; Peteiro Vazquez, Jesus ; Rigo, Fausto ; Nikolic, Aleksandra ; Ostojic, Miodrag ; Gaibazzi, Nicola ; Kovacevic-Preradovic, Tamara ; Cerracchio, Emma ; Tripepi, Giovanni Luigi ; Yin, Lixue ; Villari, Bruno ; Pepi, Mauro ; Carerj, Scipione ; Pellikka, Patricia A ; Picano, Eugenio |
| Abstract [eng] |
Introduction: Transthoracic echocardiography (TTE) identifies a hypercontractile phenotype (HP) in chronic coronary syndromes (CCS), characterized by elevated resting left ventricular (LV) elastance (force = systolic blood pressure/end-systolic volume). To evaluate the prognostic significance and functional correlates of HP. Methods: In a prospective multicentre study, 10 677 patients with CCS underwent resting TTE to assess LV ejection fraction (EF), stroke volume, and force by quantitative volumetric echocardiography. All patients were followed for the endpoint of all-cause mortality. In a subset of 5834 patients, stress echocardiography (exercise or dobutamine) was performed for LV contractile reserve and heart rate reserve. Results: Patients were stratified into Force quintiles (Q1–Q5). Patients with hypercontractile phenotype exhibited lower stroke volume at rest (Q5 = 34.8 ± 12.3 vs Q1–Q4 = 57.4 ± 19.1 mL; P 6.11 mmHg/mL; 1.88; P 4.1 (present in 185, 3.2% of the population) survived. Conclusion: Patients with CCS with HP assessed by resting TTE demonstrate higher mortality and multilayered functional impairment, including reduced LV contractile and chronotropic reserves. Hypercontractile phenotype improved the prediction of mortality by EF. A ‘stronger’ heart is, in fact, functionally and prognostically weaker. |
