Predictors of cardiac events after cardiac resynchronization therapy with tissue Doppler-derived parameters.
BACKGROUND
To evaluate the prognostic value of tissue Doppler imaging (TDI)-derived parameters (E/E' ratio and Tei index) in heart failure (HF) patients who underwent cardiac resynchronization therapy (CRT).


RESULTS
The study comprised 74 consecutive HF patients (mean age 60 +/- 11 years) who underwent CRT. Echocardiography including TDI measurements was performed in all patients at baseline and 3 months after CRT. During a median follow-up period of 720 days (range 210 to 1020 days), 21 patients (28%) had events (8 deaths, and hospitalization for HF in the remaining 13). From the baseline clinical and echocardiography data, univariable Cox-regressions analysis revealed that only diabetes (hazard ratio [HR] 3.703, P < .01), E/A ratio (HR 3.492, P < .001), and E/E' ratio (HR 1.130, P < .001) were predictors for cardiac events. From the 3-month follow-up data, the E/A ratio (HR 2.988, P < .005), E/E' ratio (HR 1.170, P < .001), left ventricular ejection fraction (HR 0.835, P < .01), deceleration time (HR 0.977, P < .05), and the Tei index (HR 15.784, P < .001) were predictors for cardiac events. After multivariable analysis, only diabetes (HR 5.544, P < .05), the 3-month E/E' ratio (HR 1.229, P < .001), and change in Tei index (HR 32.174, P < .001) were independent predictors for cardiac events. Patients with a high baseline and 3-month follow-up E/E' ratio had an 88% cardiac event rate.


CONCLUSIONS
The Tei index and E/E' ratio are independent predictors of poor response and cardiac events after CRT.
Soliman
Osama I I
OI
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Theuns
Dominic A M J
DA
Ten Cate
Folkert J
FJ
Nemes
Attila
A
Caliskan
Kadir
K
Balk
Aggie H M M
AH
Vletter
Wim B
WB
Jordaens
Luc J
LJ
Geleijnse
Marcel L
ML
D017147:Defibrillators, Implantable; D018450:Disease Progression; D015150:Echocardiography, Doppler / Q000379:methods*; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate / Q000639:trends