Prognostic Value of Ventricular-Arterial Coupling and B-Type Natriuretic Peptide in Patients After Myocardial Infarction: A Five-Year Follow-Up Study

Background: The aim of this study was to determine the prognostic role of ventricular-arterial coupling compared with B-type natriuretic peptide (BNP) in patients after myocardial infarctions. Methods: Forty-one consecutive patients with history of myocardial infarctions were enrolled. Ventricular-arterial coupling was assessed as the ratio between arterial elastance (E-a) and end-systolic ventricular elastance (E-es). E-a and E-es were calculated using systolic and diastolic blood pressure, echocardiographically derived stroke volume, left ventricular ejection fraction, and the ratio between aortic preejection time and total systolic time. Cardiovascular mortality was the prespecified endpoint, with 5-year follow-up. Results: BNP was significantly correlated with New York Heart Association class and known echocardiographic parameters of systolic and diastolic left ventricular function and also with the E-a/E-es ratio (P = .001), which emerged as an independent correlate of BNP in multivariate analysis. The E-a/E-es ratio demonstrated good accuracy in predicting long-term cardiovascular mortality (area under the receiver operating characteristic curve, 0.73; P = .019), comparable with that of BNP in patients after myocardial infarctions. Conclusion: Ventricular-arterial coupling assessed using the E-a/E-es ratio is an independent echocardiographic correlate of BNP levels in patients with previous myocardial infarctions and has a significant role in predicting long-term cardiovascular mortality in this setting. (J Am Soc Echocardiogr 2009;22:1239-45.)