Yonsei Med J.  2021 May;62(5):391-399. 10.3349/ymj.2021.62.5.391.

Valsartan Dosage on Ventriculo-Vascular Coupling Index Dose-Dependency in Heart Failure Patients

  • 1Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
  • 2Departments of Pediatric Cardiology, Gachon University Gil Medical Center, Incheon, Korea
  • 3Departments of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
  • 4Department of Cardiology, Inha University Hospital, Incheon, Korea


Heart failure (HF) poses significant morbidity and mortality. Recently, the ventriculo-vascular coupling index (VVI) was introduced as an independent prognostic factor reflective of the overall cardiovascular performance index in HF. We aimed to determine the effectiveness of force-titration of valsartan on VVI values in HF patients.
Materials and Methods
In this multicenter and prospective observational trial, the effect of valsartan was stratified according to dosages [non-ceiling dose (NCD) vs. ceiling dose (CD)] in HF patients with left ventricular ejection fraction (LVEF) <55%. Biochemical studies, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography with VVI, the treadmill test, and the activity scale index were assessed at baseline and after 24 weeks of treatment.
One-hundred thirty-eight patients were force-titrated to either a CD group (n=81) or a NCD group (n=57). The mean age of the study participants was 59 years and 66% were male. After 6 months of follow up, left ventricular mass index (LVMI) values had significantly improved in the CD group but not in the NCD group. Intriguingly, in HF patients with a reduced ejection fraction (HFrEF) (n=52, LVEF <40%), a significant improvement in VVI was only observed in the CD group (from 2.4±0.6 to 1.8±0.5, p<0.001).
CDs of valsartan for 6 months showed better improvement in VVI, as well as LVMI, in patients with HFrEF, compared with NCDs.


Heart failure; ventricular ejection fraction; valsartan; dosage; ventriculo-vascular coupling index
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