title: Pseudonormal mitral filling is associated with similarly poor prognosis as restrictive filling in patients with heart failure and coronary heart disease: a systematic review and meta-analysis of prospective studies.
abstract: OBJECTIVE
  The study objective was to more precisely evaluate the link between the pseudonormal mitral filling pattern and death by way of systematic review and meta-analysis.
  
  
  METHODS
  Patients with heart failure (HF) and coronary artery disease (CAD) were included. Online databases were searched for prospective studies of patients with HF and CAD who had comprehensive echocardiography. Mortality in patients with pseudonormal filling was compared with restrictive filling and other nonrestrictive filling patterns, including normal and abnormal relaxation. Review Manager Version 4.2.7 software was used for the analysis.
  
  
  RESULTS
  Seven studies (5 HF and 2 CAD) were identified, and 887 patients (244 deaths) were included. The pseudonormal filling pattern conferred a 4-fold increase in odds of death compared with abnormal relaxation/normal (odds ratio 4.46; 95% confidence interval, 2.87-6.92). Outcome was similar when restrictive filling was compared with pseudonormal filling (odds ratio 1.16; 95% confidence interval, 0.78-1.74). Death was the main outcome measure.
  
  
  CONCLUSIONS
  This literature-based meta-analysis, pooling results from 7 prospective studies, demonstrates the 4-fold increase in odds of death associated with pseudonormal filling compared with abnormal relaxation/normal. The pseudonormal filling pattern and restrictive filling pattern are associated with similar risk of death. These data further support the need for a comprehensive assessment of diastolic filling, including assessment for pseudonormal filling, as part of routine echocardiographic risk stratification in patients with HF and CAD.
authors.affiliation: Department of Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Jithendra B
authors.initials: JB
authors.lastname: Somaratne
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Whalley
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.forename: Robert N
authors.initials: RN
authors.lastname: Doughty
mesh_terms: D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014463:Ultrasonography