© 2008 European Society of Cardiology
Usefulness of systolic time intervals in the identification of abnormal ventriculo-arterial coupling in stable heart failure patients
a Department of Research and Education Taiwan
b Department of Medicine, Taipei Veterans General Hospital Taiwan
c Institute of Biomedical Sciences, Academia Sinica Taipei, Taiwan
d Cardiovascular Research Center Taiwan
e Department of Public Health Taiwan
f I-Lan University Hospital, National Yang-Ming University Taipei, Taiwan
* Corresponding author. No. 201, Sec. 2, Shih-Pai Road, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan. Tel.: +866 2 28712121x2073; fax: +886 2 28717431. E-mail address: chench{at}vghtpe.gov.tw (C.-H. Chen).
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Abstract |
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Background: The ratio of effective arterial elastance (Ea) to ventricular end-systolic elastance (Ees) indicates the status of ventriculo-arterial coupling.
Aims: We investigated if systolic time intervals (pre-ejection period, PEP; ejection time, ET; and their ratio, PEP/ET) can be used to identify heart failure patients with abnormal ventriculo-arterial coupling.
Methods: Age and sex-matched study subjects included 54 apparently healthy subjects with normal left ventricular (LV) function, and stable patients with LV diastolic (n=54) and systolic dysfunction (n=54). Ees and Ea were estimated non-invasively by echocardiography, and abnormal ventriculo-arterial coupling was defined as Ea/Ees>1.2. PEP, ET, and PEP/ET were measured automatically using electrocardiography, phonocardiography, and brachial pulse volume recording.
Results: Ea/Ees>1.2 was present in 48.1% of subjects with systolic dysfunction. The PEP/ET was significantly associated with most parameters of LV structure and function, and Ea/Ees (r=0.67, p<0.001). Using PEP/ET
0.423 as cut point, the sensitivity and specificity to identify patients with Ea/Ees>1.2 were 85.7% and 84.3%, respectively for the whole population, and 84.6% and 78.6%, for patients with systolic dysfunction.
Conclusion: Abnormal ventriculo-arterial coupling was present in almost half of stable patients with systolic dysfunction. PEP/ET was useful in identifying such patients.
Key Words: Systolic time intervals • Ventricular-arterial coupling • Systolic heart failure
Received November 13, 2007; Revised June 1, 2008; Accepted September 8, 2008