Ventricular-Vascular Coupling at Rest and after Exercise Is Associated with Heart Failure Hospitalizations in Patients With Coronary Artery Disease

Background: The ventricular-vascular coupling ratio, defined as the ratio of arterial elastance (E-a) to left ventricular end-systolic elastance (E-es), has not been examined in populations with coronary artery disease (CAD), and its association with heart failure (HF) in this population is unknown. Methods: Ventricular-vascular coupling was measured at rest and after exercise using echocardiography and cuff blood pressure in 815 patients with stable CAD enrolled in the Heart and Soul Study. Adjusted Cox proportional-hazard models were used to evaluate the association between ventricular-vascular coupling and future HF hospitalizations. Results: After a median of 8.9 years, 144 patients (18%) were hospitalized for HF. After multivariate adjustment, patients in the highest tertile of E-es (rest: hazard ratio [HR], 0.31 [95% CI, 0.17-0.57; P < .001]; exercise: HR, 0.26 [95% CI, 0.13-0.50; P < .001]) were at decreased risk for HF hospitalization, while patients in the highest tertile of the E-a/E-es ratio (rest: HR, 3.36 [95% CI, 1.91-5.93; P < .001]; exercise: HR, 4.09; [95% CI, 2.22-7.51; P < .001]) were at increased risk, compared with the lowest tertiles. E-a and the relative change observed in E-es and the E-a/E-es ratio with exercise were not associated with HF hospitalizations. Conclusions: The E-a/E-es ratio and E-es, at rest and after exercise, are strongly associated with future HF hospitalizations in patients with stable CAD and low rates of baseline HF. Ventricular-vascular coupling obtained from echocardiography shows promise as a risk assessment tool for HF in patients with CAD.