title: Tissue Doppler imaging as a long-term prognostic index in left ventricular systolic dysfunction.
abstract: 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.
authors: Total Care, Rio de Janeiro, RJ - Brasil. rsaraiva@cardiol.br
authors: Roberto Magalhães
authors: RM
authors: Saraiva
authors: Rita de Cássia Castelli da
authors: Rde C
authors: Rocha
authors: Adriana Ferraz
authors: AF
authors: Martins
authors: Dario Marins
authors: DM
authors: Duarte
authors: Renata da Silva
authors: Rda S
authors: Peixoto
authors: Simone Henriques de
authors: SH
authors: Castro
authors: Carla Tavares
authors: CT
authors: Gallicchio
authors: Andréa Lúcia
authors: AL
authors: de Araújo
authors: Sérgio Emanuel
authors: SE
authors: Kaiser
mesh_terms: 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