Non-invasive Left Ventricular End Diastolic Wall Stress and the Risk of Incident Heart Failure in a Clinical Population.

Greater left ventricular (LV) wall stress has been associated with adverse clinical outcomes among patients with heart failure (HF). We examined the relation between LV wall stress and the risk of incident HF. Using data from the Vanderbilt Synthetic Derivative, we studied 29,246 adult patients without prevalent HF or ≥ moderate valve disease who underwent transthoracic echocardiography between 2014-2020. LV end diastolic wall stress (LVEDWS) was calculated from chamber and wall thickness measures and E/e' as a surrogate for LV end diastolic pressure. Incident HF was ascertained from ICD-9/10 codes. Correlates of LVEDWS were examined with multivariable linear regression. The association between LVEDWS and risk of incident HF was tested in Cox regression adjusted for demographics, comorbidities, blood pressure, body mass index, laboratory data including B-type natriuretic peptide, LVEF, and LV mass index. The cohort had a median age of 59 years, 54% females, with 11% of individuals identifying as Black. Median LVEDWS was 14.5 (IQR: 11.8-18.0) kdynes/cm2. Cross sectional correlates of LVEDWS ranked according to Chi-squared value were LVEF, heart rate, female sex, and LV mass index. Over a maximum follow-up time of 8.2 years (median 3.7 years), 3,082 (11%) individuals developed incident HF. In multivariable Cox regression, each 1-unit increase in LVEDWS significantly associated with an increased risk of incident HF (aHR: 1.019; 95%CI 1.014-1.024), which was largely consistent across subgroups. In conclusion, among a broad range of patients clinically referred for echocardiography, greater non-invasively measured LVEDWS associates with higher risk for incident HF.