Importance of Left Ventricular End-systolic Volume Index as a Prognostic Indicator in Heart Failure with Preserved Left Ventricular Ejection Fraction

Background: A prognostic efficacy of Left ventricular ejection fraction (LVEF) in heart failure with preserved LVEF (HFpEF) is unclear. Methods: We enrolled 471 patients (LVEF>&=50%) who received a catheterization study and obtained baseline characteristics including LVEF, LV end-diastolic and end-systolic volume indices (LVEDVI, LVESVI) which were measured by left ventriculography. Pressure parameters such as tau, and inertia force of late systolic aortic flow (IFLAF) were also obtained using a catheter-tipped micro-manometer. Cardiovascular death or hospitalization for HF were defined as adverse events, and prognostic values of parameters were estimated using a Cox proportional-hazard model. In addition, we compared the prognostic efficacy and correlations with pressure parameters between LVEF, LVESVI, and LVEDVI. Results: During 6.61 ± 4.08 year-follow-up, 39 adverse events were documented. The Cox model after adjustments for age, gender, and hemoglobin level demonstrated that 3 parameters had a significant prognostic value for adverse events (LVEF: HR: 0.951, 95%CI: 0.916–0.987, P = .008; LVEDVI: HR: 1.033, 95%CI: 1.017–1.049, P < .001; LVESVI: HR: 1.049, 95%CI: 1.025–1.074, P < .001) According to the comparison of AUC in the 3 parameters, the LVESVI was most accurate (AUC: 0.694, 0.351 (LVEF), 0.661 (LVEDVI)). Furthermore, the LVESVI demonstrated the strongest correlations with tau (r = 0.364, -0.284 (LVEF), 0.330 (LVEDVI)) and IFLAF (r=-0.358, 0.320 (LVEF), -0.277 (LVEDVI)) in the 3 parameters. Conclusion: Enlargement of LVESVI could be a reliable prognostic indicator in HFpEF.