title: Restrictive left ventricular filling pattern and increase in antero-posterior left atrial diameter: two reliable predictors of clinical deterioration in chronic heart failure II NYHA class patients.
abstract: OBJECTIVE
  To identify the Doppler echocardiographic criteria able to predict clinical deterioration of mild-to- moderate chronic heart failure (CHF) as well as, whenever possible, to evaluate the features of chronological relation of cavitary remodelling in left chambers during follow-up (FU).
  
  
  METHODS
  A retrospective, case-controlled study, including a number of CHF II NYHA class patients, was carried out, to evaluate, by means of univariate and multivariable logistic regression analyses, the role as predictor of CHF worsening of some Doppler echocardiographic parameters, listed as follows: left ventricular mass index, analyzed both as continuous and as dichotomous (>130 g/m2) variable; left ventricular end-systolic volume (LVESV) >57 ml; left ventricular ejection fraction (LVEF), divided into 2 classes: a) LVEF>45%, i.e. normal or mildly impaired LVEF, and 2) reduced (45%-30%) LVEF; restrictive left ventricular filling pattern (RFP); antero-posterior left atrial diameter (LADi) >50 mm; ratio of early mitral inflow to early myocardial velocity>8.
  
  
  RESULTS
  Of 173 patients enrolled, 60 patients (15 cases of transition to III NYHA class and 45 controls) were included in retrospective analysis. At univariate analysis, RFP and LADi>50 mm were shown to be associated with worsening of CHF. At multivariate analysis, the role of prognostic indicator of poor outcome was maintained by RFP (OR=17.0, 95%CI: 2.5-116.5) as well as by LADi>50 mm (OR=7.95, 95%CI: 1.27.0-49.6). On the other hand, in the subset of CHF with LVEF >45%, increased LADi was not associated with occurrence of increase in LVESV or left ventricular progressive dilation during the subsequent follow-up.
  
  
  CONCLUSIONS
  In mild-to-moderate CHF, RFP and LADi>50 mm are predictors of adverse outcome, independently of the presence or severity of left ventricular systolic dysfunction.
authors.affiliation: Cardiology Unit, Presidio Sanitario Intermedio Elena d' Aosta, Naples, Italy. r.de.vecchis@alice.it
authors.forename: Renato
authors.initials: R
authors.lastname: De Vecchis
authors.forename: Carmela
authors.initials: C
authors.lastname: Cioppa
authors.forename: Anna
authors.initials: A
authors.lastname: Giasi
authors.forename: Armando
authors.initials: A
authors.lastname: Pucciarelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cantatrione
mesh_terms: D000704:Analysis of Variance; D016022:Case-Control Studies; D002908:Chronic Disease; D018450:Disease Progression; D004452:Echocardiography; D006325:Heart Atria / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*