Elsevier

American Heart Journal

Volume 143, Issue 6, June 2002, Pages 1101-1106
American Heart Journal

Clinical Investigations: Congestive Heart Failure
Deceleration time of early filling in patients with left ventricular systolic dysfunction: Functional and prognostic independent value,☆☆

Presented in part at the Twenty-second Congress of the European Society of Cardiology, Amsterdam, The Netherlands, August 26-30, 2000.
https://doi.org/10.1067/mhj.2002.122119Get rights and content

Abstract

Background Although diastolic function parameters have been mentioned as significant predictors of functional capacity and prognosis in patients with left ventricular (LV) systolic dysfunction, it has not been fully elucidated whether they keep an independent predictive value when multiple parameters from a wide variety of examinations are considered. Methods We prospectively studied 60 patients with New York Heart Association (NYHA) class II-IV chronic heart failure symptoms and LV ejection fraction <0.4. At the time of entry into the study, demographic data and functional class were obtained, and usual Doppler echocardiographic, radionuclide ventriculographic, cardiopulmonary exercise testing and hemodynamic variables were determined. Deceleration time of early filling (DT) and NYHA functional class were the only independent predictors of functional capacity as assessed by means of peak oxygen uptake (peak Vo2). Mean follow-up was 21 ± 6 months, and event-free survival was defined as the absence of cardiac death, urgent cardiac transplantation, or hospital admission requiring inotropic or mechanical support. Results Multivariate Cox analysis showed that DT (P =.008), peak Vo2 (P =.01), and NYHA class (P =.02) were independent predictors of event-free survival at 1 year. Patients in the lowest tertile of DT (<130 ms) had a significantly lower event-free survival than patients in the intermediate (44% vs 80%, P =.03) and in the highest tertile (44% vs 83%, P =.02). Patients with both a DT <130 milliseconds and a peak Vo2 <14 mL/kg/min had the highest rate of events at 1 year (83% vs 22% for the remaining patients, relative risk 3.75, P <.001). Conclusions In patients with LV systolic dysfunction, DT is a powerful independent predictor of functional capacity and prognosis among a wide variety of variables. A shortened DT (<130 ms) identifies a subgroup of patients with a worse outcome, especially when combined with a reduced peak Vo2 (<14 mL/kg/min). (Am Heart J 2002;143:1101-6.)

Section snippets

Study population

Sixty consecutive patients with NYHA class II-IV chronic heart failure symptoms and moderate to severe left ventricular (LV) dysfunction (ejection fraction <40% by radionuclide ventriculography) were included between January 1996 and November 1997 and were prospectively studied in our heart failure unit. Patients were not considered for inclusion if they had sustained ventricular tachyarrhythmias (n = 2) or any severe systemic disease (n = 2) that might shorten survival. Six patients with

Prediction of functional capacity

Results of Doppler-echocardiography, radionuclide ventriculography, cardiopulmonary exercise testing and hemodynamic studies are summarized in Table II.

The better univariate correlations with peak Vo2 were found for DT (r = 0.65, P <.001; Figure 1) and for NYHA functional class (r = 0.64, P <.001) as it is reflected in Table III.

. Relationship between DT and peak Vo2.

There was a moderate relationship between peak Vo2 and radionuclide ejection fraction (r = 0.5, P <.01). Lower but significant

Discussion

The present study demonstrates the importance of diastolic function in patients with congestive heart failure and depressed LV systolic function, with special focus on a simple parameter of Doppler echocardiography such as DT. Among a wide variety of variables, DT independently predicts functional capacity and prognosis in these patients. The information provided by this parameter, specially when combined with that of peak Vo2, allows for the stratification of patients with LV systolic

References (21)

There are more references available in the full text version of this article.

Cited by (16)

  • The prognostic significance of restrictive diastolic filling associated with heart failure: A meta-analysis

    2007, International Journal of Cardiology
    Citation Excerpt :

    Despite repeated attempts, confirmation was not possible for 7 studies [5,10,16,17,19,22,39]. Of these, 6 studies clearly reported numbers in the publication [5,10,16,17,19,22] and these unconfirmed numbers were used in the analysis, the remaining one study may have been eligible but was not included [39]. One author combined the results of two studies to exclude overlapping patients [32,33].

  • Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure

    2004, American Journal of Cardiology
    Citation Excerpt :

    In the present study, left atrial volume had reasonable sensitivity for CHF, but had low specificity, consistent with previous data indicating that patients with reduced ejection fraction may have enlarged atria independent of left ventricular filling pressure.16 Previous studies have demonstrated the value of conventional Doppler (mitral inflow and pulmonary venous parameters) in detecting elevated left ventricular filling pressures.14,23,24 Yamamoto et al18 and Ommen et al7 demonstrated that conventional Doppler is accurate in patients with reduced ejection fraction, but inaccurate in patients with normal ejection fraction.

View all citing articles on Scopus

Reprint requests: Francisco J. Morales, MD, Servicio de Cardiología, Hospital Universitario Puerto Real, Carretera Nacional IV, Km 665, Puerto Real (Cádiz), Spain.

☆☆

E-mail: [email protected]

View full text