title: Transmitral flow patterns and the presence of chronic kidney disease provide independent and incremental prognostic information in patients with heart failure and systolic dysfunction.
abstract: BACKGROUND
  Transmitral flow patterns derived from Doppler echocardiography carry prognostic information in patients with chronic heart failure and systolic dysfunction. In such patients, chronic kidney disease (CKD) defined as a reduction in estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) is frequent, but its prognostic impact relative to that of transmitral flow patterns is unknown.
  
  
  METHODS
  This prospective study enrolled 292 patients with stable chronic heart failure and systolic dysfunction (mean ejection fraction 30 +/- 10), of whom 148 had CKD. Echocardiographic measurements comprised left ventricular dimensions/volumes, ejection fraction, the ratio of early (E) to late (A) transmitral flow velocity, deceleration time, and tissue Doppler mitral annular velocities. The mitral filling pattern (FP) was classified as either restrictive FP (RFP) or non-RFP. A cardiac event (cardiac death or urgent cardiac transplantation) was defined as combined study end point.
  
  
  RESULTS
  During a follow-up of 497 +/- 373 days, 45 patients had a cardiac event (cardiac death, n = 42; urgent cardiac transplantation, n = 3). On multivariate Cox analysis including clinical and echocardiographic variables, independent prognostic predictors were RFP (hazard ratio: 2.77, 95% confidence interval 1.28-6.09), CKD (hazard ratio: 2.79, 95% confidence interval 1.24-6.28), and left atrial diameter. In patients with RFP, the prognosis was markedly worse in the presence of CKD as compared with the absence (event-free survival of 23% vs 83%, P = .03). Similarly, in patients with non-RFP, outcome was worse in the presence of CKD (event-free survival of 71% vs 88%, P = .003).
  
  
  CONCLUSIONS
  In patients with chronic heart failure and systolic dysfunction, the presence of CKD adds incremental value to transmitral flow patterns in determining the prognosis.
authors.affiliation: Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany. bruchc@uni-muenster.de <bruchc@uni-muenster.de>
authors.forename: Christian
authors.initials: C
authors.lastname: Bruch
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.forename: Markus
authors.initials: M
authors.lastname: Rothenburger
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.forename: Jörg
authors.initials: J
authors.lastname: Stypmann
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Wichter
authors.forename: Rainer
authors.initials: R
authors.lastname: Gradaus
mesh_terms: D001783:Blood Flow Velocity; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging* / Q000401:mortality*; D015897:Comorbidity; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*