Heart failure by ventricle-arterial coupling in STEMI

Left ventricular-arterial coupling (VAC), calculated as the ratio between arterial elastance (Ea) and left ventricular end-systolic elastance (Ees), is part of contemporary non-invasive indices of left ventricular (LV) and arterial system function. It may assist in identifying post-STEMI patients at risk of major adverse cardiovascular events, including heart failure.

To analyse the development and applicability in routine clinical practice of simplified echocardiographic methods for calculating left VAC and predicting the risk of heart failure post-STEMI.

Echocardiography was performed on 144 post-STEMI patients who were followed up for 750 days after hospitalisation. Each baseline characteristic variable was analysed using the Wilcoxon and Shapiro-Wilk tests. Kaplan-Meier methods with log-rank tests and Cox regression were employed to assess the risk of heart failure based on two main variables: VAC values within the range of 0.95-1.1, and values outside this range. VAC was measured using Chen’s method, which includes systolic and diastolic pressure, preejection time, total ejection time, ejection fraction, and stroke volume. All analyses were conducted using StataMP 14.1.

We enrolled 144 patients, of whom 87% (n=125) were male, with a median age of 60 years. Initially, 76.3% (n=106) of patients had reduced ejection fraction at the first echocardiography. The most common comorbidities were hypertension (52%) and type 2 diabetes (40.3%). In our initial comparison of VAC values, Kaplan-Meier curves demonstrated significant differences in the incidence of heart failure between VAC 0.95-1.1 and values outside this range. The VAC 0.95-1.1 group showed a better prognosis (p-value < 0.0312), with no occurrences of heart failure during the 750-day follow-up.

Established parameters for VAC vary across different scenarios, but conclusive information is lacking for patients in acute myocardial infarction. We propose that enhancing the Ea/Ees ratio (measured by Chen’s method) and thereby VAC could provide clinicians with detailed prognostic information, potentially preventing heart failure.

Heart failure and VAC