Importance of echocardiography in patients with severe nonischemic heart failure: the second Prospective Randomized Amlodipine Survival Evaluation (PRAISE-2) echocardiographic study.
BACKGROUND
Echocardiography is used commonly in clinical practice when caring for patients with heart failure. It is unknown whether the presence of certain findings provides an incremental ability to predict survival beyond the use of baseline clinical findings alone. The second PRAISE-2 echocardiographic study was prospectively designed to identify echocardiographic predictors of survival among patients with nonischemic cardiomyopathy and heart failure and to determine if components of the echocardiographic examination add prognostic information to baseline demographic and clinical information.


METHODS
One hundred patients participated in the second Prospective Randomized Amlodipine Survival Evaluation Study (PRAISE-2) echocardiographic study; of these, 93 had full and interpretable echocardiographic examinations. Cox proportional hazards modeling was used to assess the relation between various characteristics and survival as well as to assess the incremental prognostic information gained by echocardiography beyond the clinical examination.


RESULTS
Seven of 10 routine echocardiographic measures were significantly associated with death. These included mitral regurgitation (hazard ratio [HR], 2.31; 95% CI, 1.02, 5.27), left ventricular ejection fraction <20% (HR, 2.59; 95% CI, 1.14, 5.88), restrictive left ventricular filling pattern (HR, 2.37; 95% CI, 1.05, 5.32), and peak D velocity (HR, 1.62; 95% CI, 0.38, 0.87). The only statistically significant clinical predictor of survival was dyspnea at rest. The addition any of several echocardiographic parameters to baseline clinical information significantly improved the ability to predict survival.


CONCLUSIONS
Several readily available echocardiographic parameters are predictive of death and when added to clinical examination findings significantly improve the ability to determine prognosis among patients with nonischemic cardiomyopathy and heart failure.
Cabell
Christopher H
CH
Duke University School of Medicine, Durham, NC, USA. chris.cabell@duke.edu
Trichon
Benjamin H
BH
Velazquez
Eric J
EJ
Dumesnil
Jean G
JG
Anstrom
Kevin J
KJ
Ryan
Thomas
T
Miller
Alan B
AB
Belkin
Robert N
RN
Cropp
Anne B
AB
O'Connor
Christopher M
CM
Jollis
James G
JG
D017311:Amlodipine / Q000627:therapeutic use; D001783:Blood Flow Velocity; D004311:Double-Blind Method; D004417:Dyspnea / Q000401:mortality; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D017311:Amlodipine