Prognostic Value of Ventricular-Arterial Coupling and B-Type Natriuretic Peptide in Patients After Myocardial Infarction: A Five-Year Follow-Up Study
published online 27 September 2009.
Background
The aim of this study was to determine the prognostic role of ventricular-arterial coupling compared with B-type natriuretic peptide (BNP) in patients after myocardial infarctions.
Methods
Forty-one consecutive patients with history of myocardial infarctions were enrolled. Ventricular-arterial coupling was assessed as the ratio between arterial elastance (Ea) and end-systolic ventricular elastance (Ees). Ea and Ees were calculated using systolic and diastolic blood pressure, echocardiographically derived stroke volume, left ventricular ejection fraction, and the ratio between aortic preejection time and total systolic time. Cardiovascular mortality was the prespecified endpoint, with 5-year follow-up.
Results
BNP was significantly correlated with New York Heart Association class and known echocardiographic parameters of systolic and diastolic left ventricular function and also with the Ea/Ees ratio (P = .001), which emerged as an independent correlate of BNP in multivariate analysis. The Ea/Ees ratio demonstrated good accuracy in predicting long-term cardiovascular mortality (area under the receiver operating characteristic curve, 0.73; P = .019), comparable with that of BNP in patients after myocardial infarctions.
Conclusion
Ventricular-arterial coupling assessed using the Ea/Ees ratio is an independent echocardiographic correlate of BNP levels in patients with previous myocardial infarctions and has a significant role in predicting long-term cardiovascular mortality in this setting.
aCardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
bChimica Clinica, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
c“Prof Dr C. C. Iliescu” Institute of Cardiovascular Diseases, Bucharest, Romania
d“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
eDepartment of Cardiology, Elias Hospital, Bucharest, Romania
Reprint requests: Francesco Antonini-Canterin, MD, Cardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Via Montereale, 24, 33170 Pordenone, Italy
Drs Enache, B. A. Popescu, and A. C. Popescu were supported by research fellowships from the Association for Research in Cardiology (Pordenone, Italy).
ABSTRACT