The prognostic value of systolic mitral annular velocity measured with Doppler tissue imaging in patients with chronic heart failure due to left ventricular systolic dysfunction

Nikolay P Nikitin ^1*, Poay Huan Loh ¹, Ramesh de Silva ¹, Justin Ghosh ¹, Olga Y Khaleva ¹, Kevin Goode ¹, Alan S Rigby ¹, Farqad Alamgir ¹, Andrew L Clark ¹ and John GF Cleland ¹

¹ The University of Hull, United Kingdom

^* To whom correspondence should be addressed. E-mail: n.p.nikitin{at}hull.ac.uk.

Accepted 29 September 2005

Abstract

Objective: This study was designed to assess the prognostic value of various conventional and novel echocardiographic indices in patients with chronic heart failure (CHF) due to left ventricular (LV) systolic dysfunction.

Methods: We prospectively enrolled 185 patients aged 67(11) years with CHF and LV ejection fraction <45% despite optimal pharmacological treatment. The patients underwent 2D echocardiography with tissue harmonic imaging to assess global LV systolic function and obtain volumetric data. Transmitral flow was assessed with conventional pulse wave Doppler. Systolic (Sm), early and late diastolic mitral annular velocities were measured with the use of colour-coded Doppler tissue imaging (DTI).

Results: During a median follow-up of 32 months (range 24 to 38 months in survivors), 34 patients died and one underwent heart transplantation. Sm velocity (p=0.011), diastolic arterial pressure (p=0.015), serum creatinine (p=0.023), LV ejection fraction (p=0.024), age (p=0.052), LV end-systolic volume index (p=0.067), and restrictive pattern of transmitral flow (p=0.074) predicted the outcome of death or transplantation on univariate analysis. On multivariate analysis, only Sm velocity (HR=0.648, 95%CI (0.460-0.912), p=0.013) and diastolic arterial pressure (HR=0.966, 95%CI (0.938-0.994), p=0.016) emerged as independent predictors of outcome.

Conclusions: In patients with CHF and LV systolic dysfunction despite optimal pharmacological treatment, the strongest independent echocardiographic predictor of prognosis was systolic mitral annular Sm velocity measured with quantitative colour-coded DTI.

Keywords: diastole, Doppler echocardiography, congestive heart failure, prognosis, left ventricular dysfunction

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