Tissue Doppler imaging as a long-term prognostic index in left ventricular systolic dysfunction.
BACKGROUND
Tissue Doppler parameters correlate with left ventricular (LV) filling pressure and can be useful as prognostic indexes for patients with heart failure.


OBJECTIVE
Determine whether tissue Doppler parameters can predict events during long term follow-up of outpatients with LV systolic dysfunction.


METHODS
Retrospective study with 73 patients (aged 60.9+/-12.1 years) who underwent Doppler echocardiogram between March 2001 and May 2004. The primary endpoint studied was death or hospitalization due to heart failure worsening.


RESULTS
The mean follow-up period was 1,367+/-665 days. After logistic stepwise multivariate analysis, including echocardiographic parameters, the ratio of maximal early diastolic filling wave velocity to maximal early diastolic myocardial velocity (E/E; ratio; p=0.0007), and LV ejection fraction (EF; p=0.01) remained significant predictors of the primary outcome. The optimal cutoffs for primary endpoint prediction for E/E' ratio (AUC 0.77; p=0.0001) and EF (AUC 0.68, p=0.006) were respectively 12.7 and 30%. Accordingly, patients with E/E' ratio > 12.7 (hazard ratio=3.8, p =0.001) or EF <30% (hazard ratio=2.3, p=0.03) had a poorer outcome by survival curve analysis. It is noteworthy that 47% of the patients with EF above the optimal cutoff point, but with high E/E' ratio, presented events during follow-up.


CONCLUSIONS
E/E' ratio is an important independent long-term prognostic index of death or hospitalization due to worsening heart failure in outpatients with LV systolic dysfunction. Therefore, we recommend the measurement of this variable in the routine evaluation of such patients.
Saraiva
Roberto Magalhães
RM
Total Care, Rio de Janeiro, RJ - Brasil. rsaraiva@cardiol.br
Rocha
Rita de Cássia Castelli da
Rde C
Martins
Adriana Ferraz
AF
Duarte
Dario Marins
DM
Peixoto
Renata da Silva
Rda S
Castro
Simone Henriques de
SH
Gallicchio
Carla Tavares
CT
de Araújo
Andréa Lúcia
AL
Kaiser
Sérgio Emanuel
SE
D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality