title: Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: an individual patient meta-analysis.
abstract: BACKGROUND
  The Doppler echocardiographic restrictive mitral filling pattern (RFP) is an important prognostic indicator in patients with heart failure (HF), but the interaction between RFP, left ventricular ejection fraction (LVEF) and filling pattern remains uncertain.
  
  
  OBJECTIVE
  To determine whether the RFP is predictive of mortality independently of LVEF in patients with HF.
  
  
  METHODS
  Online databases were searched to identify studies assessing the relationship between prognosis and LV filling pattern in patients with HF. Individual patient data from 18 studies (3540 patients) were extracted and collated at the MeRGE Coordinating Centre (The University of Auckland).
  
  
  RESULTS
  Overall, RFP was associated with higher all-cause mortality than the non-restrictive filling pattern: hazard ratio 2.42 (95% CI 2.06, 2.83). In multivariable analysis the RFP, LVEF, NYHA class and age were independent predictors of mortality. The prevalence of the RFP was inversely related to LVEF but remained a predictor of mortality even in those patients with preserved LVEF.
  
  
  CONCLUSIONS
  The restrictive mitral filling pattern is a powerful predictor of mortality, independent of LVEF and age, in patients with HF. Doppler-derived LV filling patterns are an accessible marker from echocardiography that can readily be incorporated in risk stratification of all patients with HF.
authors.forename: R N
authors.initials: RN
authors.lastname: Doughty
authors.forename: A L
authors.initials: AL
authors.lastname: Klein
authors.forename: K K
authors.initials: KK
authors.lastname: Poppe
authors.forename: G D
authors.initials: GD
authors.lastname: Gamble
authors.forename: F L
authors.initials: FL
authors.lastname: Dini
authors.forename: J E
authors.initials: JE
authors.lastname: Møller
authors.forename: M
authors.initials: M
authors.lastname: Quintana
authors.forename: C M
authors.initials: CM
authors.lastname: Yu
authors.forename: G A
authors.initials: GA
authors.lastname: Whalley
mesh_terms: D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*