title: Tissue Doppler imaging in patients with advanced heart failure: relation to functional class and prognosis.
abstract: BACKGROUND
  Tissue Doppler imaging (TDI) provides rapid assessment of systolic and diastolic myocardial function. However, the added value of TDI to standard Doppler echocardiographic measurements in predicting symptoms and outcome of advanced heart failure remains unknown.
  
  
  METHODS
  The study cohort comprised 45 patients with congestive heart failure, defined as New York Heart Association functional class III and IV, who were referred to our department for evaluation for heart transplantation. Twenty healthy subjects were the controls. Conventional echo Doppler was used to assess left ventricular (LV) ejection fraction, peak velocities of transmitral early and late diastolic LV filling, the ratio of transmitral early to late LV filling velocity, and E-deceleration time. TDI measurements recorded at the mitral annulus included systolic velocity, early and late diastolic velocities, and the ratio of early to late diastolic velocity. The ratio of transmitral early LV filling velocity to early diastolic TDI velocity of the mitral annulus (E/E') was calculated. All patients were followed for cardiac-related death and hospitalization for heart failure.
  
  
  RESULTS
  Patients with functional class IV had a significantly higher E/E' ratio than did patients with functional class III (12.9 +/- 2.8 vs 8.3 +/- 1.7, p < 0.001) and the controls (5.4 +/- 1.3, p < 0.001). Except for transmitral late filling velocity, all conventional echo Doppler parameters and TDI variables significantly correlated with functional class. On multivariate stepwise analysis, however, the E/E' ratio was the only independent predictor of functional class (p = 0.003). E/E' also correlated with cardiac mortality and hospitalization.
  
  
  CONCLUSIONS
  Conventional Doppler indices and TDI parameters correlated with functional class in patients with advanced heart failure. The E/E' ratio, which probably reflects high LV end-diastolic pressure, was the best measure for differentiating patients with functional class III and IV, and it also correlated with cardiac mortality and hospitalization for worsening heart failure, thereby providing additional value to standard echocardiographic measures.
authors.affiliation: Echocardiography Unit, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel. ashrafh@clalit.org.il
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.forename: Tuvia
authors.initials: T
authors.lastname: Bengal
authors.forename: Mali
authors.initials: M
authors.lastname: Mansur
authors.forename: Mordehay
authors.initials: M
authors.lastname: Vaturi
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Sulkes
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: Alex
authors.initials: A
authors.lastname: Sagie
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole / Q000502:physiology; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000145:classification* / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D012044:Regression Analysis; D012720:Severity of Illness Index; D013599:Systole / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology