Prognostic role of left ventricular-arterial сoupling parameters in patients with heart failure with preserved ejection fraction: an open-label observational study

Aim. To evaluate the prognostic significance of left ventricular (LV) end-systolic elastance (Ees), arterial elastance (Ea), and left ventricular-arterial coupling (LVAC) in outpatients aged 60 years and older with heart failure with preserved ejection fraction (HFpEF). Material and methods. The study included 116 outpatients (44% men) aged 60-89 years with class II-IV HF. The endpoints were hospitalization due to cardiovascular disease (CVD) and all-cause mortality. The follow-up period was 35 (22-36) months. Results. The median LV Ees was 3,18 (2,60-4,11) mm Hg/ml, LVAC — 1,49 (1,221,68), Ea — 2,24 (1,88-2,57) mm Hg/ml. The cut-off for predicting hospitalization due to CVD was ≲3,20 mm Hg/ml for LV Ees (OR=2,32, p<0,05), ≲1,49 for LVAC (OR=2,01, p<0,05). Mortality was higher in patients with LV Ees ≲2,92 mm Hg/ml (OR=3,84, p<0,05) and LVAC ≲1,26 (OR=8,40, p<0,05). ROC-curves for Ea did not demonstrate predictive potential for CVD-related hospitalization or mortality in patients aged 60 years and older with HFpEF. Survival was higher in patients with LV Ees >2,92 mm Hg/mL compared with patients with LV Ees ≲2,92 mm Hg/mL (Log-rank, p=0,016). Similarly, survival was higher in patients with LVAC >1,26 versus LVAC ≲1,26 (Log-rank, p=0,001). Conclusion. The obtained data allow us to consider LV Ees and LVAC as markers with significant prognostic potential in stratifying the risk of adverse outcomes (hospitalization, mortality) in older HFpEF-outpatients.