title: Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction.
abstract: OBJECTIVE
  This study sought to investigate the relative and incremental prognostic value of demographic, historical, clinical, echocardiographic and mitral Doppler variables in patients with left ventricular systolic dysfunction.
  
  
  BACKGROUND
  The prognostic value of diastolic abnormalities as assessed by mitral Doppler echocardiography has yet to be defined.
  
  
  METHODS
  A total of 508 patients with left ventricular ejection fraction < or = 35% were followed up for a mean (+/- SD) period of 29 +/- 11 months.
  
  
  RESULTS
  During the follow-up period, 148 patients (29.1%) were admitted to the hospital for congestive heart failure, and 100 patients (19.7%) died. By Cox model analysis, Doppler-derived mitral deceleration time of early filling < or = 125 ms (relative risk [RR] 1.93, 95% confidence interval [CI] 1.4 to 3.7), New York Heart Association functional class III or IV (RR 1.49, 95% CI 1.4 to 2.3), ejection fraction < or = 25% (RR 1.85, 95% CI 1.6 to 2.9), third heart sound (RR 2.06, 95% CI 1.8 to 3.2), age > 60 years (RR 1.95, 95% CI 1.8 to 3.1) and left atrial area > 18 cm2 (RR 1.73, 95% CI 1.6 to 2.7) were all found to be independent and additional predictors of all-cause mortality, and deceleration time was the single best predictor (chi-square 37.80). When all these significant variables were analyzed in hierarchic order, after age, functional class, third sound, ejection fraction and left atrial area, deceleration time still added significant prognostic information (global chi-square from 9.2 to 104.7). Also, deceleration time was the strongest independent predictor of hospital admission for congestive heart failure (RR 4.88, 95% CI 3.7 to 6.9) and cumulative events (congestive heart failure or all-cause mortality, or both; RR 2.44, 95% CI 2.0 to 3.8) in both symptomatic and asymptomatic patients.
  
  
  CONCLUSIONS
  Deceleration time of early filling is a powerful independent predictor of poor prognosis in patients with left ventricular systolic dysfunction, whether symptomatic or asymptomatic. A short (< or = 125 ms) deceleration time by mitral Doppler echocardiography adds important prognostic information compared with other clinical, functional and echocardiographic variables.
authors.affiliation: Salvatore Maugeri Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Division of Cardiology, Medical Center of Rehabilitation, Veruno (NO), Italy.
authors.forename: P
authors.initials: P
authors.lastname: Giannuzzi
authors.forename: P L
authors.initials: PL
authors.lastname: Temporelli
authors.forename: E
authors.initials: E
authors.lastname: Bosimini
authors.forename: P
authors.initials: P
authors.lastname: Silva
authors.forename: A
authors.initials: A
authors.lastname: Imparato
authors.forename: U
authors.initials: U
authors.lastname: Corrà
authors.forename: M
authors.initials: M
authors.lastname: Galli
authors.forename: A
authors.initials: A
authors.lastname: Giordano
mesh_terms: D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D013599:Systole / Q000502:physiology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology