Prognostic value of the atrial systolic mitral annular motion velocity in patients with left ventricular systolic dysfunction

doi:10.1016/S0894-7317(02)74537-9

Journal of the American Society of Echocardiography

Volume 16, Issue 4, April 2003, Pages 333-339

https://doi.org/10.1016/S0894-7317(02)74537-9 Get rights and content

Abstract

Background: Transmitral flow velocity variables are powerful predictors of poor prognosis in patients with left ventricular (LV) systolic dysfunction. However, these variables may not accurately reflect the severity of pulmonary congestion. This study was designed to determine whether the peak atrial systolic mitral annular motion velocity (MA-Aw) measured by pulsed Doppler tissue imaging can predict cardiac death or hospitalization for worsening heart failure in patients with LV systolic dysfunction.

Methods: MA-Aw was recorded in 96 patients with LV systolic dysfunction who were followed up for 29 ± 10 months. All patients underwent Doppler echocardiography on entry into the study, and cardiac catheterization was performed in 45 patients. Patients were divided into 3 groups on the basis of the ratio of early (E) to late (A) diastolic filling (E/A) of the transmitral flow velocity: group 1 (n=31; E/A < 1); group 2 (n=37; 1 ≤ E/A < 2); and group 3 (n=28; E/A ≥ 2).

Results: During follow-up, 36 patients (38%) died of cardiac causes and 34 (35%) were hospitalized for worsening heart failure. There were 2 cardiac deaths (6%) in group 1, 14 (39%) in group 2, and 20 (56%) in group 3. The MA-Aw correlated closely with the mean pulmonary capillary wedge pressure. Univariate Cox model analysis showed that MA-Aw ≤ 5 cm/s was the most powerful predictor of cardiac death or hospitalization for worsening heart failure compared with clinical, hemodynamic, and the other echocardiographic variables. Furthermore, MA-Aw ≤ 5 cm/s was clearly discernible as a good predictor of cardiac mortality on multivariate Cox model and as assessed by Kaplan-Meier method.

Conclusion: The MA-Aw obtained by pulsed Doppler tissue imaging is a sensitive index of pulmonary congestion in patients with LV systolic dysfunction. It is a simple and noninvasive outcome measure and can be used to monitor treatment.

Section snippets

Patient selection

A total of 96 consecutive patients (28 women and 68 men; mean age, 56 ± 8 years) with LV systolic dysfunction and diffuse asynergy as a result of either ischemic or nonischemic dilated cardiomyopathy, or specific heart muscle disease, were enrolled. All patients underwent Doppler echocardiography, and 45 underwent cardiac catheterization (initial examination) as clinically indicated. All patients had been clinically stable for at least 4 weeks on oral therapy. Inclusion criteria were in sinus

Baseline characteristics

Baseline clinical, M-mode, 2D, color flow Doppler, pulsed, and Doppler tissue echocardiographic data (96 patients) and hemodynamic characteristics (45 patients) in the 3 groups are presented in Table 1. Heart rate and systolic blood pressure were significantly increased and lower, respectively, in group 3 than in group 1. The percentage of patients in NYHA functional class III or IV was greater in groups 2 and 3 than in group 1. LV EF was lower in groups 2 and 3 than in group 1, although the LV

Discussion

This is the first report to demonstrate that the atrial systolic mitral annular motion velocity obtained by pulsed DTI is a better predictor for prognosis or severity of pulmonary congestion compared with E-DT, E/A of transmitral flow velocity, or E of transmitral flow velocity/Ew of mitral annulus in patients with LV systolic dysfunction.

Recently, it has been reported that the transmitral flow velocity is useful index for evaluating LV diastolic function, and that it predicts outcome in

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Original ArticlePrognostic value of the atrial systolic mitral annular motion velocity in patients with left ventricular systolic dysfunction

Abstract

Section snippets

Patient selection

Baseline characteristics

Discussion

Lancet

Am J Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

Am J Cardiol

Original Article
Prognostic value of the atrial systolic mitral annular motion velocity in patients with left ventricular systolic dysfunction