Prognostic value of pulse-wave tissue Doppler parameters in patients with systolic heart failure.
The aim was to study the prognostic value of left ventricular (LV) function using pulse-wave tissue Doppler imaging (TDI) in an ordinary population with heart failure (HF). One hundred fifty-six patients hospitalized for HF and LV ejection fraction < or =40% were examined using conventional echocardiography and pulse-wave TDI for the assessment of longitudinal LV function. Mitral annular systolic and early diastolic (e') velocities were recorded from a mean of 4 annular sites from the apical 2- and 4-chamber views. Noninvasive LV filling pressure was calculated from the ratio between transmitral early inflow velocity (E) and e'. All patients were followed up for 2 years, and data from the National Registry of Deaths were collected. Mean LV ejection fraction was 24.7 +/- 7.2%. TDI recordings showed a mean mitral annular systolic velocity of 5.0 +/- 1.0 cm/s and e' velocity of 6.2 +/- 1.9 cm/s. E/e' ratio was 14.1 +/- 4.8. Thirty patients (19%) had atrial fibrillation. During follow-up, 27 patients (17%) died of a cardiovascular cause. Multivariate analysis showed that only E/e' ratio and age were predictors of cardiovascular mortality. A cut-off value for E/e' ratio >13 had sensitivity of 84% and specificity of 45% to identify patients who died within 2 years of cardiac reasons. In conclusion, in the acute stage of HF, E/e' ratio is a strong independent predictor of long-term cardiovascular mortality in an ordinary population with HF and systolic dysfunction. Systolic and diastolic velocities had no independent prognostic value.
Olson
Jens M
JM
Department of Cardiology, Karolinska Institute at South Hospital (Södersjukhuset), Stockholm, Sweden. jens.olsson@sodersjukhuset.se
Samad
Bassem A
BA
Alam
Mahbubul
M
D000367:Age Factors; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D018617:Ultrasonography, Doppler, Pulsed