[Echocardiographic prediction of outcome in patients with congestive heart failure and mitral regurgitation].
BACKGROUND
Congestive heart failure is associated with the increase risk of death or cardiac transplantation. The ability of current techniques to predict outcome in heart failure is rather limited. Identification of the patients at risk of cardiac death or requiring heart transplantation is clinically important. The changing rate of left ventricular pressure during the cardiac cycle is an important parameter in the assessment of myocardial systolic function. Non-invasive echocardiographic method--dP/dt has been proposed to determine the isovolumic phase of cardiac function. The aim of this study was to evaluate the ability of Doppler-derived dP/dt to predict survival in patients with congestive heart failure.


METHODS
Thirty one patients (22M, 9W), mean age 55 +/- 11.2 years, with CHF (LVEF < 45%, NYHA II-IV class) and chronic mitral regurgitation were analyzed. The echocardiography, cardiopulmonary exercise test and clinical follow-up were performed in all of them. The ejection fraction was calculated using the Simpson's method from apical 4-chamber view. The dP/dt index was derived from the continuous-wave Doppler spectrum. The mean follow-up period was 28.5 +/- 12 months. According to the clinical status the patients were divided into two groups: group I--21 event-free patients and group II--10 patients who experienced primary events (5 died and 5 underwent heart transplantation).


RESULTS
In the group of primary events patients there was noted a significant decrease of the dP/dt index in comparison to the event-free patients: 463 mmHg/s vs 839 mmHg/s (p=0.0001). The correlation between dP/dt and ejection fraction, left ventricular end-diastolic diameter as well as between the parameters of cardiopulmonary exercise test VO2peak, VO2AT, VE/VCO2peak was found.


CONCLUSIONS
Doppler echocardiographic index of dP/dt can predict the outcome in patients with congestive heart failure. Dp/dt can be useful as a prognostic factor in patients with CHF. A significant correlation was observed between dP/dt and VO2peak as well as VE/VCO2peak which are independent prognostic predictors.
Leśniak-Sobelga
Agata
A
Klinika Chorób Serca i Naczyń, Instytut Kardiologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. alesniak@szpitaljp2.krakow.pl
Tomkiewicz-Pajak
Lidia
L
Olszowska
Maria
M
Podolec
Piotr
P
Szustka
Ewa
E
Tracz
Wiesława
W
D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D011237:Predictive Value of Tests