Straw Sam, Brown Oliver I, Cole Charlotte A, Lowry Judith E, Conning-Rowland Marcella, Kamalathasan Stephe, Datla Sushma, Paton Maria F, Burgess Ruth, Drozd Michael, Slater Thomas A, Relton Samuel D, Levelt Eylem, Witte Klaus K, Kearney Mark T, Cubbon Richard M, Gierula John
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom. (S.S., O.I.B., M.C.-R., M.F.P., M.D., T.A.S., E.L., K.K.W., M.T.K., R.M.C., J.G.).
Leeds Teaching Hospitals NHS Trust, United Kingdom (C.A.C., J.E.L., S.K., R.B.).
Circ Cardiovasc Imaging. 2025 Jul 16:e018370. doi: 10.1161/CIRCIMAGING.125.018370.
Left ventricular ejection fraction (LVEF) is an essential tool for heart failure (HF) assessment but is limited by load dependence. Additional tools are needed to risk-stratify normal LVEF populations. We aimed to assess the prognostic value of systolic blood pressure-indexed left ventricular end-systolic volume ratio, or cardiac contractility index (CCI).
In a prospective observational cohort study of people newly diagnosed with HF, we defined characteristics and outcomes associated with LVEF and CCI, including after stratification into HF with reduced ejection fraction or HF with preserved ejection fraction. We used UK Biobank to assess whether CCI is associated with subclinical myocardial dysfunction and incident HF.
In people with HF, mortality increased over tertiles of declining CCI (<0.001). Within the HF preserved ejection fraction group, below-median CCI was associated with distinct clinical characteristics and an all-cause mortality risk approximately twice that of those with above median CCI (observed event rate 17.3/100 patient-years versus 8.8/100 patient-years; <0.001), similar to those with HF with reduced ejection fraction. Modeled as continuous variables, there was a curvilinear relationship between mortality across the detected range of CCI, while there was no clear association with mortality risk across a wide range of LVEF (20%-55%). In UK Biobank for participants without HF and normal LVEF, below-median CCI was associated with ≈33% increased risk of incident heart failure (adjusted hazard ratio, 1.33 [1.01-1.75]; =0.043). Decreasing CCI was also associated with lower myocardial contractility defined using global radial and circumferential strain.
CCI is a simple, noninvasive, relatively afterload-independent method to stratify HF risk in populations with normal LVEF. Its simplicity means CCI could be applied to existing clinical trial data sets or used be as an inclusion criterion in future randomized controlled trials.
左心室射血分数（LVEF）是心力衰竭（HF）评估的重要工具，但受负荷依赖性限制。需要额外的工具对LVEF正常的人群进行风险分层。我们旨在评估收缩压校正的左心室收缩末期容积比（即心脏收缩指数，CCI）的预后价值。
在一项对新诊断为HF的患者进行的前瞻性观察队列研究中，我们确定了与LVEF和CCI相关的特征及预后，包括分层为射血分数降低的HF或射血分数保留的HF之后的情况。我们利用英国生物银行评估CCI是否与亚临床心肌功能障碍及新发HF相关。
在HF患者中，CCI下降的三分位数组死亡率增加（<0.001）。在射血分数保留的HF组中，CCI中位数以下与不同的临床特征相关，全因死亡风险约为CCI中位数以上者的两倍（观察到的事件发生率为17.3/100患者年对8.8/100患者年；<0.001），与射血分数降低的HF患者相似。以连续变量建模，在检测到的CCI范围内，死亡率之间存在曲线关系，而在较宽的LVEF范围（20%-55%）内与死亡风险无明显关联。在英国生物银行中，对于无HF且LVEF正常的参与者，CCI中位数以下与新发心力衰竭风险增加约33%相关（校正风险比，1.33[1.01-1.75]；P=0.043）。CCI降低还与使用整体径向和圆周应变定义的较低心肌收缩力相关。
CCI是一种简单、无创、相对独立于后负荷的方法，可对LVEF正常人群的HF风险进行分层。其简单性意味着CCI可应用于现有临床试验数据集，或用作未来随机对照试验的纳入标准。
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