Prognostic significance of diastolic dysfunction by tissue Doppler imaging in patients with chronic heart failure.
BACKGROUND
This study assesses the prognostic values of left ventricular (LV) filling patterns, as determined by tissue Doppler imaging (TDI), on cardiac events in patients with LV systolic dysfunction. Normally observed in patients with an advanced form of cardiac disease, an abnormal diastolic pattern by Doppler echocardiography reflects a poor prognosis. Recent studies using TDI have significantly contributed to efforts to evaluate diastolic function and demonstrate the prognostic importance of TDI-derived indices of the LV function.


RESULTS
One hundred seventy-three consecutive adult patients, mean (standard deviation) age of 62.4 (14.3), with a diagnosis of dilated cardiomyopathy and LV ejection fraction <45% were enrolled. During a follow-up period of 321 +/- 100 days, 9 patients expired from cardiac complications and 29 underwent readmission for decompensated heart failure. In multivariate analysis, only the mean value of early (Em) and late (Am) diastolic velocities ratio assessed by TDI, and LV end-diastolic pressure were found to be independent predictors of a cardiac event. The optimal cutoff value for forecasting cardiac event was Em/Am > or = 0.74 with an area under the receiver operating characteristic curve of 0.82; sensitivity and specificity were 84% and 76%, respectively (P < 0.001; standard error = 0.046).


CONCLUSIONS
Em/Am ratio is the important predictor of cardiac event, which allows normalization for other risk factors in patients with a clinical diagnosis of chronic heart failure with LV dysfunction comparing with conventional Doppler echocardiography.
Lee
Cheng-Hung
CH
Second Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, 105 Taiwan.
Hsieh
Ming-Jer
MJ
Chu
Chi-Ming
CM
Chen
Chun-Chi
CC
Hsieh
I-Chang
IC
Hung
Kuo-Chun
KC
Wen
Ming-Shien
MS
Lin
Fun-Chung
FC
Wu
Delon
D
D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity