title: Usefulness of a combination of systolic function by left ventricular ejection fraction and diastolic function by E/E' to predict prognosis in patients with heart failure.
abstract: Left ventricular (LV) ejection fraction (EF) was known as a conventional predictor of heart failure (HF). However, early transmitral flow velocity (E)/early diastolic velocity of mitral annulus (E') correlated well with LV end-diastolic pressure, and E/E' ratio >15 was an excellent predictor of adverse outcomes in patients with HF. This study was designed to determine the prognostic value of a new combined index, E/E' ratio and LVEF, in patients with HF. One hundred twenty-six consecutive patients hospitalized with HF underwent comprehensive echocardiographic-Doppler study when ready for discharge. Patients were divided into the 4 groups of group I (LVEF >40% and E/E' ratio <15), group II (EF >40% and E/E' ratio >or=15), group III (EF <or=40% and E/E' ratio <15), and group IV (EF <or=40% and E/E' ratio >or=15). The ability of this index to determine the primary end point (rehospitalization for HF or cardiac death) was assessed. Patients with significant valvular disease were excluded. Of 126 patients, 110 met the inclusion criteria. Follow-up was complete for 108 of 110 patients at 351 +/- 252 days after discharge. There were 27, 30, 21, and 30 patients in groups I, II, III, and IV, respectively. There were 52 patients with the primary end point. On univariate analysis, E/E' ratio, group IV, E', and age were significant predictors. In multivariable analysis, the most powerful independent prognostic indicator of events was group IV (hazard ratio 12.6, 95% confidence interval 2.2 to 74.2, p = 0.005). In conclusion, a new index, a combination of LVEF and E/E' ratio, allowed the identification of patients at higher risk of readmission and cardiac death in patients with HF.
authors.affiliation: Department of Cardiology, Wakayama Medical University, Wakayama, Japan. hiratakumiko@aol.com
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Eiichi
authors.initials: E
authors.lastname: Hyodo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hozumi
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kita
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirose
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sakanoue
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nishida
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kawarabayashi
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D003971:Diastole / Q000502:physiology; D018450:Disease Progression; D018618:Echocardiography, Doppler, Color; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology*; D006334:Heart Function Tests; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality*