title: Independent and incremental prognostic value of early mitral annulus velocity in patients with impaired left ventricular systolic function.
abstract: OBJECTIVE
  This study sought to investigate the incremental prognostic value of non-invasive measures of early myocardial relaxation and left ventricular diastolic pressure (LVDP) in patients with impaired left ventricular (LV) systolic function.
  
  
  BACKGROUND
  The early diastolic mitral annulus velocity (Em) reflects myocardial relaxation, and the combined ratio of the early transmitral flow velocity (E) to Em (E/Em) >15 correlates well with elevated mean LVDP. It is unknown if these new indexes will predict poorer survival in patients with LV systolic dysfunction.
  
  
  METHODS
  Echocardiograms were prospectively obtained in 182 patients with impaired LV systolic function, defined as an LV ejection fraction <0.50. The end point was cardiac mortality. The majority of this patient sample (80%) has been reported on in a previous publication.
  
  
  RESULTS
  After a median 48 months' follow-up, Em emerged as an independent predictor of survival (hazard ratio 0.61, 95% confidence interval 0.45 to 0.82). An Em <3 cm/s was associated with a significantly excess mortality (log-rank statistic 9.36, p = 0.002), and this measurement added incremental prognostic value to standard indexes of systolic or diastolic function, including a deceleration time <140 ms and an E/Em >15 (p = 0.038).
  
  
  CONCLUSIONS
  Early diastolic mitral annulus velocity is a powerful predictor of cardiac mortality in patients with LV systolic impairment; Em <3 cm/s emerged as the best prognosticator in long-term follow-up, incremental to other clinical or echocardiographic variables, including the ratio E/Em.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Gabriel
authors.initials: G
authors.lastname: Yip
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Deko
authors.initials: D
authors.lastname: Tse
authors.forename: Shun-Ling
authors.initials: SL
authors.lastname: Kong
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D003971:Diastole / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D013599:Systole / Q000502:physiology*; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology*