title: Prognostic value of tissue Doppler imaging in patients with chronic congestive heart failure.
abstract: BACKGROUND
  The prognostic value of tissue Doppler imaging (TDI) in patients with chronic congestive heart failure (CHF) has not been compared against conventional measures of systolic, diastolic and overall left ventricular LV performance. The aim of this study was to assess the prognostic value of TDI-derived parameters in patients with CHF.
  
  
  METHODS
  One hundred thirty-two subjects with chronic CHF [due to ischemic (n=82) or dilated (n=50) cardiomyopathy, 101 males, mean age 57+/-11 years] underwent conventional two-dimensional/Doppler echocardiography and assessment of the Tei-index (isovolumic contraction time and isovolumic relaxation time divided by ejection time). Systolic, early and late diastolic mitral annular velocities (S', E' and A') were derived from pulsed TDI. A cardiac event (cardiac death, urgent cardiac transplantation or hospitalization due to decompensated CHF) was defined as the combined study endpoint.
  
  
  RESULTS
  The patients were followed for a mean of 224+/-123 days. Thirty-one patients suffered an event (cardiac death, n=5; urgent cardiac transplantation, n=2; hospitalization due to CHF, n=24). In patients with event, ejection fraction was lower (25+/-10 vs. 32+/-9%), mitral deceleration time was shorter (138+/-58 vs. 193+/-72 ms), and the peak mitral E/E'-ratio (16.1+/-6.6 vs. 10.6+/-5.0) was significantly elevated as compared to patients free of events (p<0.001 for all comparisons). In those patients, the Tei-index was elevated (1.09+/-0.39 vs. 0.86+/-0.26, p<0.01), and a restrictive mitral filling pattern was more frequent (51.6 vs. 17.5%, p<0.001). Stepwise multivariate analysis identified the mitral E/E'-ratio (p<0.001) and the Tei-index (p=0.019) as the only independent predictors of a combined event. E/E'-ratio was the best predictor of hospitalization due to CHF also. In patients with mitral E/E'-ratio>12.5 or Tei-index>0.90, outcome was poor.
  
  
  CONCLUSIONS
  In subjects with chronic CHF, the mitral E/E'-ratio is a stronger predictor of future cardiac events than conventional parameters of systolic, diastolic or overall LV performance. The E/E'-ratio may be a useful addition in the routine follow-up of such patients.
authors.affiliation: Department of Cardiology and Angiology, University Hospital of Münster, Germany.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Acil
authors.forename: Thomas
authors.initials: T
authors.lastname: Wichter
authors.forename: Jörg
authors.initials: J
authors.lastname: Stypmann
authors.forename: Frauke
authors.initials: F
authors.lastname: Janssen
authors.forename: Matthias
authors.initials: M
authors.lastname: Paul
authors.forename: Matthias
authors.initials: M
authors.lastname: Grude
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Christian
authors.initials: C
authors.lastname: Bruch
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D015588:Observer Variation; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016019:Survival Analysis; D016277:Ventricular Function, Left