Hypercontractile phenotype at rest in chronic coronary syndromes predicts impaired functional reserve and increased mortality
Authors' conclusion
Patients with CCS with HP assessed by resting TTE demonstrate higher mortality and multilayered functional impairment, including reduced LV contractile and chronotropic reserves. Hypercontractile phenotype improved the prediction of mortality by EF. A ‘stronger’ heart is, in fact, functionally and prognostically weaker.
Study context
- Population
- Patients with chronic coronary syndromes (CCS) undergoing resting transthoracic echocardiographystress echocardiography in a subset of 5834 patients · Stress echocardiography subset 5,834
- Participants
- 10,677 patients
- Exposure
- Force quintiles; hypercontractile phenotype vs Q1-Q4
- Outcome
- Stroke volume at rest
Main finding
As reported in the abstract
P < 0.01
Observational data: associations, not effects.
Further findings
| Outcome | Values | HR (95% CI) | P value | |
|---|---|---|---|---|
| All-cause mortality · median follow-up of 24 months (interquartile range = 12-40 months)Q5vs Q3Multivariable analysis | Q1 exposure-adjusted death rate 2.88 per 100 person/years · Q2 exposure-adjusted death rate 1.86 per 100 person/years · Q3 exposure-adjusted death rate 1.03 per 100 person/years · Q4 exposure-adjusted death rate 1.56 per 100 person/years · Q5 exposure-adjusted death rate 1.88 per 100 person/years | 1.531 (1.116–2.099) | P = 0.006 | |
| 0.512Hazard ratio (log scale) |
All-cause mortality · median follow-up of 24 months (interquartile range = 12-40 months)
| HR (95% CI) | P value | ||
|---|---|---|---|
| EFMultivariable analysis; independent predictor of death | 0.963 (0.953–0.972) | P < 0.0001 | |
| 0.512Hazard ratio (log scale) |
| Outcome | Values | P value |
|---|---|---|
| EF at restQ5 vs Q1-Q4 · higher EF with HP | Q5 64.8 ± 6.9% % · Q1-Q4 58.1 ± 8.7% % | P < 0.01 |
| LV contractile reserve (ΔEF) during exercise or dobutamine stressQ5 vs Q1-Q4 · reduced with HP | Q5 4.3 ± 9.4% % · Q1-Q4 7.0 ± 9.3% % | P < 0.001 |
| Heart rate reserve during stressQ5 vs Q1-Q4 · blunted with HP | Q5 1.77 ± 0.33 · Q1-Q4 1.85 ± 0.39 | P < 0.01 |
- All-cause mortality — Deaths
- 509
- All-cause mortality: Q5: P < .0001 vs Q1 and Q3
Survival with force-based left ventricular (LV) contractile reserve >4.1
- All patients with force-based LV contractile reserve >4.1 survived (present in 185, 3.2% of the population)
- 185
Original publication
Hypercontractile phenotype at rest in chronic coronary syndromes predicts impaired functional reserve and increased mortality. ESC Heart Fail. Published 6 June 2026. doi:10.
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