title: Loading manipulations improve the prognostic value of Doppler evaluation of mitral flow in patients with chronic heart failure.
abstract: BACKGROUND
  Mitral flow velocity patterns (MFVPs) evaluated by Doppler echocardiography are strong predictors of survival in various cardiac diseases. However, MFVPs may change over time according to loading conditions. We performed this prospective study to assess whether changes in MFVP induced by loading manipulations provided additional prognostic information in 173 patients with chronic heart failure.
  
  
  RESULTS
  Simultaneous Doppler echocardiographic and right-sided hemodynamic recordings were obtained at baseline in all patients, during nitroprusside infusion in the 98 patients who had a baseline restrictive (early-to-late flow velocity ratio > 1 and deceleration time < or = 130 ms) MFVP, and during passive leg lifting in the 75 patients who had a baseline nonrestrictive MFVP. Patients were categorized, according to changes in MFVP, into four groups: 61 patients with an irreversible restrictive, 37 with a reversible restrictive, 48 patients with a stable nonrestrictive, and 27 patients with an unstable nonrestrictive MFVP. Fifty patients experienced major cardiac events. Cox analysis revealed that MFVP was a strong predictor of events and that the response to loading manipulations improved its prognostic value. Patients with an irreversible restrictive MFVP had a higher event rate (51%) than patients with a reversible restrictive MFVP (19%). Among patients with a baseline nonrestrictive MFVP, those with a stable nonrestrictive MFVP had the lowest event rate (6%), whereas the event rate was 33% in patients with an unstable nonrestrictive MFVP.
  
  
  CONCLUSIONS
  In patients with chronic heart failure, MFVPs provide independent prognostic information. Their prognostic value can be further increased by assessment of the changes induced in them by loading manipulations.
authors.affiliation: Salvatore Maugeri Foundation, IRCCS, Montescano Medical Center, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pozzoli
authors.forename: E
authors.initials: E
authors.lastname: Traversi
authors.forename: G
authors.initials: G
authors.lastname: Cioffi
authors.forename: R
authors.initials: R
authors.lastname: Stenner
authors.forename: M
authors.initials: M
authors.lastname: Sanarico
authors.forename: L
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D001794:Blood Pressure; D002216:Captopril / Q000627:therapeutic use; D003326:Coronary Circulation; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D009599:Nitroprusside / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011379:Prognosis; D011652:Pulmonary Circulation; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D000319:Adrenergic beta-Antagonists; D004071:Digitalis Glycosides; D004232:Diuretics; D014665:Vasodilator Agents; D009599:Nitroprusside; D002216:Captopril; D000638:Amiodarone