title: Impact of left ventricular remodeling on diagnostic and prognostic value of tissue Doppler indices in chronic systolic heart failure.
abstract: BACKGROUND
  The ratio of peak transmitral pulsed Doppler early velocity to early diastolic tissue Doppler velocity (TDI) of the lateral or septal mitral annulus (E/Ea) is considered a reliable estimation of LV filling pressure. We aim to examine the impact of left ventricular (LV) dimensions on the relationship between lateral and septal E/Ea in the determination of diastolic dysfunction patterns in the setting of chronic systolic heart failure (HF).
  
  
  RESULTS
  In 207 patients with chronic systolic HF (LV ejection fraction ≤40%, New York Heart Association Classes I-IV), comprehensive transthoracic echocardiography was performed and long-term outcomes followed up to a median of 40 months. The median lateral and septal Ea (interquartile range) were 7.0 (4.7 to 9.5) cm/s and 4.5 (3.5 to 5.6) cm/s, respectively. The median E/lateral Ea, E/septal Ea, and E/average Ea (interquartile range) were 10.8 (7.1 to 15.1), 16.1 (11.1 to 23.0), and 12.7 (8.8 to 17.7), respectively. In the first 2 tertiles of indexed left ventricular end-diastolic volume (LVEDVi) (<92 mL/m(2) and 92 to 130 mL/m(2)), all 3 E/Ea indices rise with increasing diastolic stage (all P < .001). However, in the highest tertile of indexed LVEDVi (≥130 mL/m(2)), E/average Ea and E/septal Ea (but not E/lateral Ea) increased with increasing diastolic stage, and only E/septal Ea correlated with natriuretic peptide levels (r = 0.38, P = .018) and adverse cardiac events (Hazard ratio 1.91, 95% confidence interval 1.25 to 2.96, P = .003).
  
  
  CONCLUSIONS
  In the setting of chronic systolic heart failure with extensive cardiac remodeling, septal TDI measurements may be more reliable and clinically relevant than lateral TDI measurements in the assessment of diastolic dysfunction.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. tangw@ccf.org
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Kevin
authors.initials: K
authors.lastname: Shrestha
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
authors.forename: Allen G
authors.initials: AG
authors.lastname: Borowski
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Martin
authors.forename: Richard W
authors.initials: RW
authors.lastname: Troughton
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
mesh_terms: D004452:Echocardiography; D005260:Female; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000473:pathology*; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011379:Prognosis; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D018608:Ultrasonography, Doppler; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology*; D020257:Ventricular Remodeling
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain