Heart failure
Prognostic Value of Pulse-Wave Tissue Doppler Parameters in Patients With Systolic Heart Failure

https://doi.org/10.1016/j.amjcard.2008.04.054Get rights and content

The aim was to study the prognostic value of left ventricular (LV) function using pulse-wave tissue Doppler imaging (TDI) in an ordinary population with heart failure (HF). One hundred fifty-six patients hospitalized for HF and LV ejection fraction ≤40% were examined using conventional echocardiography and pulse-wave TDI for the assessment of longitudinal LV function. Mitral annular systolic and early diastolic (e′) velocities were recorded from a mean of 4 annular sites from the apical 2- and 4-chamber views. Noninvasive LV filling pressure was calculated from the ratio between transmitral early inflow velocity (E) and e′. All patients were followed up for 2 years, and data from the National Registry of Deaths were collected. Mean LV ejection fraction was 24.7 ± 7.2%. TDI recordings showed a mean mitral annular systolic velocity of 5.0 ± 1.0 cm/s and e′ velocity of 6.2 ± 1.9 cm/s. E/e′ ratio was 14.1 ± 4.8. Thirty patients (19%) had atrial fibrillation. During follow-up, 27 patients (17%) died of a cardiovascular cause. Multivariate analysis showed that only E/e′ ratio and age were predictors of cardiovascular mortality. A cut-off value for E/e′ ratio >13 had sensitivity of 84% and specificity of 45% to identify patients who died within 2 years of cardiac reasons. In conclusion, in the acute stage of HF, E/e′ ratio is a strong independent predictor of long-term cardiovascular mortality in an ordinary population with HF and systolic dysfunction. Systolic and diastolic velocities had no independent prognostic value.

Section snippets

Methods

Patients with signs and symptoms of acute decompensated heart failure (HF) who were admitted to the Department of Cardiology at Sodersjukhuset, Stockholm, Sweden, from September 1999 to April 2004 were screened for this study. Patients were asked to participate if LV ejection fraction was ≤40%. Exclusion criteria were LV ejection fraction >40%, severe valvular disease, and age >85 years. Eventually, 156 patients were included in the study. Before discharge and in a reasonably stable clinical

Results

Table 1 lists baseline clinical characteristics of the study population. Table 2 lists conventional and TDI parameters obtained at the examination that initiated the study. Mean LV ejection fraction was severely depressed at 25%. All surviving patients were followed up for ≥24 months. During follow-up, 27 patients (17%) died of a cardiovascular cause and thus reached the study end point. Table 3 lists the output of univariate Cox regression analysis. Factors that affected the outcome of

Discussion

This study was the first to investigate the prognostic importance of TDI parameters in a mixed population with HF and severe LV systolic dysfunction that included patients with atrial fibrillation. Our study showed that the E/e′ ratio measured in the acute stage of hospitalization was the most powerful predictor of cardiovascular death in this type of population This parameter was superior to other echocardiographic and clinical variables, such as LV ejection fraction, LV end-diastolic

Acknowledgment

We thank Eva Andersson and Johan Wardell for valuable technical help.

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This work was supported by a grant from Stockholms läns landsting (ALF medicine), Stockholm, Sweden.

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