Introduction
Diastolic function cannot be optimally assessed by one measure alone, but is best assessed using a combination of several echocardiographic indices in patients with heart failure with preserved ejection fraction (HFpEF).1–3 Patients with HFpEF have an increased left atrial volume (LAV), which is an index of LAV overload, and an increased E/e’, which is an index of left atrial (LA) pressure overload.4 5 We previously reported the ratio of left ventricular (LV) diastolic elastance (Ed) to arterial elastance (Ea) as a novel index of afterload-integrated diastolic function, which can be calculated as (E/e’)/(0.9×systolic blood pressure).6 Ed/Ea exhibits an LA pressure relative to the systemic pressure.7 Thus, the Ed/Ea ratio may reflect the left-sided heart function, including the atrio-ventricular-arterial interaction, under a preserved LV ejection fraction (LVEF).
We recently reported that Ed/Ea may be a useful independent determinant of all-cause mortality in the elderly patients with HFpEF showing sinus rhythm.8 However, during follow-up time, the value of prognostic factors may change, especially in the elderly patients, and the altered extent may affect the prognosis. LVEF is reported to change after discharge in patients with heart failure.9 10 The changes in the N-terminal pro-brain natriuretic peptide (NT-proBNP) levels after discharge have been related to prognostic changes in patients with HFpEF.11 Furthermore, for the clarification of prognostic factors for HFpEF, we typically focus on combining echocardiographic markers with other types of general predictive factors. This study aimed to clarify the differences in the role of Ed/Ea in relation to follow-up time and other common prognostic factors for predicting all-cause mortality in patients with HFpEF.