Journal of the American Society of Echocardiography
Volume 22, Issue 11 , Pages 1239-1245, November 2009

Prognostic Value of Ventricular-Arterial Coupling and B-Type Natriuretic Peptide in Patients After Myocardial Infarction: A Five-Year Follow-Up Study

  • Francesco Antonini-Canterin, MD

      Affiliations

    • Cardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
    • Corresponding Author InformationReprint requests: Francesco Antonini-Canterin, MD, Cardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Via Montereale, 24, 33170 Pordenone, Italy
    • ,
  • Roxana Enache, MD

      Affiliations

    • “Prof Dr C. C. Iliescu” Institute of Cardiovascular Diseases, Bucharest, Romania
    • ,
  • Bogdan Alexandru Popescu, MD, PhD, FESC

      Affiliations

    • “Prof Dr C. C. Iliescu” Institute of Cardiovascular Diseases, Bucharest, Romania
    • “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
    • ,
  • Andreea Catarina Popescu, MD, PhD, FESC

      Affiliations

    • “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
    • Department of Cardiology, Elias Hospital, Bucharest, Romania
    • ,
  • Carmen Ginghina, MD, PhD, FESC, FACC

      Affiliations

    • “Prof Dr C. C. Iliescu” Institute of Cardiovascular Diseases, Bucharest, Romania
    • “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
    • ,
  • Elisa Leiballi, MD

      Affiliations

    • Cardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
    • ,
  • Rita Piazza, MD

      Affiliations

    • Cardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
    • ,
  • Daniela Pavan, MD

      Affiliations

    • Cardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
    • ,
  • Daniela Rubin, MD

      Affiliations

    • Chimica Clinica, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
    • ,
  • Piero Cappelletti, MD

      Affiliations

    • Chimica Clinica, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy
    • ,
  • Gian Luigi Nicolosi, MD, FESC, FACC

      Affiliations

    • Cardiologia, ARC, Azienda Ospedaliera “S Maria Degli Angeli”, Pordenone, Italy

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.

Keywords: Ventricular arterial coupling, Arterial stiffness, B-type natriuretic peptide, Myocardial infarction

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 Drs Enache, B. A. Popescu, and A. C. Popescu were supported by research fellowships from the Association for Research in Cardiology (Pordenone, Italy).

PII: S0894-7317(09)00760-3

doi:10.1016/j.echo.2009.08.009

Journal of the American Society of Echocardiography
Volume 22, Issue 11 , Pages 1239-1245, November 2009

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