title: Reversible restrictive left ventricular diastolic filling with optimized oral therapy predicts a more favorable prognosis in patients with chronic heart failure.
abstract: OBJECTIVE
  We sought to assess whether in clinically stable patients with chronic heart failure (CHF) the prolongation (i.e., increase) of an initially short (< or = 125 ms) Doppler transmitral deceleration time (DT) of early filling obtained with long-term optimal oral therapy predicts a more favorable prognosis.
  
  
  BACKGROUND
  It has been recently demonstrated that transmitral early DT is a powerful independent predictor of poor prognosis in patients with left ventricular dysfunction. However, DT may change over time according to loading conditions and medical treatment.
  
  
  METHODS
  One hundred forty-four patients with CHF and a short DT (< or = 125 ms) underwent repeat Doppler echocardiographic study 6 months after the initial examination, while clinically stable with optimal oral therapy, and were then followed up for a mean period of 26 +/- 7 months.
  
  
  RESULTS
  After 6 months, DT had not changed in 80 patients (group 1), whereas it was significantly prolonged (> 125 ms) in the remaining 64 patients (group 2). Baseline Doppler echocardiographic features were similar in the two groups. No changes were found after 6 months in group 1, whereas group 2 showed a slight but significant (p < 0.01) reduction in end-systolic volume, an improvement in left ventricular ejection fraction (p < 0.01) and a decrease (p < 0.01) in the degree of tricuspid regurgitation. During follow-up, 37% of patients in group 1 experienced cardiac death versus 11% in group 2 (p < 0.0005). By Cox model analysis, prolongation of a short DT emerged as the single best predictor of survival (chi-square 15.70).
  
  
  CONCLUSIONS
  The prolongation of an initially short DT obtained with long-term optimal oral therapy predicts a more favorable outcome in clinically stable patients with CHF.
authors.affiliation: Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, Istituto di Ricovero e Cura a Carattiere Scientifico, Division of Cardiology, Medical Center of Rehabilitation, Veruno, Italy. cdl@intercom.it
authors.forename: P L
authors.initials: PL
authors.lastname: Temporelli
authors.forename: U
authors.initials: U
authors.lastname: Corrà
authors.forename: A
authors.initials: A
authors.lastname: Imparato
authors.forename: E
authors.initials: E
authors.lastname: Bosimini
authors.forename: F
authors.initials: F
authors.lastname: Scapellato
authors.forename: P
authors.initials: P
authors.lastname: Giannuzzi
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012039:Regional Blood Flow; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D002317:Cardiovascular Agents