title: Serial changes in systolic and diastolic echocardiographic indices as predictors of outcome in patients with decreased left ventricular ejection fraction.
abstract: BACKGROUND
  Echocardiographic estimation of left ventricular ejection fraction aids in predicting adverse outcomes in coronary artery disease. However, in patients with impaired left ventricular function, further risk stratification is difficult.
  
  
  METHODS
  A 2 year retrospective review was performed to identify patients with ejection fraction < or=30%. Echocardiographic measures of systolic and diastolic function were independently performed offline. Outcome information, which included MI, stroke, or death, was obtained. The patient cohort identified those with follow-up having 1) a single echocardiogram and a subset 2) with an initial echocardiogram and a second echocardiogram at greater than one year follow-up.
  
  
  RESULTS
  This study included 110 patients, ages 20-94. Mean follow-up time was 29+/-9 months. Ejection fraction did not predict cardiovascular events. LV mass predicted of mortality (p=0.03). Diastolic indexes of mitral inflow E wave was a significant predictor of outcome (p=0.05). Impaired diastolic filling grade 2, 3, or 4 showed a 76% event rate. Decreases in ejection fraction at follow-up were seen in those who had an event, with an average decrease in ejection fraction of 17% versus those who lived with no event of 1%. Changes in mitral inflow E wave and changes in E/A ratio were both significant predictors of outcome.
  
  
  CONCLUSIONS
  These data indicate that echocardiographic measures of both systolic and diastolic function aid in risk stratifying patients with decreased ejection fraction. The changed detected in serial echocardiographic information may be important in treatment and secondary prevention of future events.
authors.affiliation: Department of Internal Medicine/Cardiology, Saint Louis University School of Medicine, 3635 Vista Avenue, 14th Floor, Desloge Towers, St. Louis, MO 63110-2539, USA. smbierig@yahoo.com
authors.forename: S Michelle
authors.initials: SM
authors.lastname: Bierig
authors.forename: Amanda
authors.initials: A
authors.lastname: Ryan
authors.forename: Ali
authors.initials: A
authors.lastname: Ziaee
authors.forename: Larry
authors.initials: L
authors.lastname: Kociolek
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Simon
authors.forename: Steven
authors.initials: S
authors.lastname: Herrmann
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Labovitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013599:Systole / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*