The Prognostic Utility of Echo‐Estimated Left Ventricular End‐Diastolic Pressure–Volume Relationship in Stable Coronary Artery Disease: The Heart and Soul Study

Background While changes in the left ventricular end-diastolic pressure–volume relationship (LV-EDPVR) can be estimated using echocardiography, their prognostic utility in stable coronary artery disease (CAD) is unknown. Methods Using echo-estimated LV end-diastolic volume index and diastolic function category, the relative position of the LV-EDPVR was defined in 901 participants with stable CAD as: (1) left-shifted, (2) right-shifted, or (3) intermediate. We then evaluated the association of LV-EDPVR position relative to the intermediate category with time to hospitalization for heart failure (HF) or cardiovascular (CV) death using Cox proportional hazards models. Results During 7.0 ± 3.1 years of follow-up, there were 207 admissions for HF or CV deaths. Both leftward and rightward shifts of LV-EDPVR were associated with a significantly higher risk of HF or CV death (HR 1.73, 95% CI 1.15–2.62 and HR 6.75, 95% CI 4.02–11.31, respectively). In multivariable-adjusted models, these associations were attenuated but remained significant (HR 1.66, 95% CI 1.08–2.55 for left-shifted and HR 4.19, 95% CI 2.32–7.55 for right-shifted). The association of LV-EDPVR with HF or CV death was no longer significant after inclusion of N-terminal pro-brain natriuretic peptide level as a covariate. Conclusions In stable CAD, echo-estimated leftward and rightward shifts in the LV-EDPVR are associated with HF and CV death. The loss of these associations after adjustment for N-terminal pro-brain natriuretic peptide level suggests that echo-estimated LV-EDPVR captures changes in LV filling pressure at any given LV end-diastolic volume.