Different prognostic impact of the tissue Doppler-derived E/e' ratio on mortality in Chagas cardiomyopathy patients with heart failure.
BACKGROUND
Risk assessment of Chagas cardiomyopathy patients is essential for clinical decision making. The ratio of the ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/e') is a powerful predictor of adverse outcome in patients with heart failure. However, its prognostic value remains to be established in the setting of Chagas cardiomyopathy. This study investigated the effect of E/e' on mortality according to different degrees of left ventricular (LV) systolic function in patients with Chagas cardiomyopathy.


METHODS
The study prospectively enrolled 232 patients (143 men) with Chagas cardiomyopathy (mean age, 48 ± 12 years). End points were death or cardiac transplantation.


RESULTS
During a mean follow-up of 3.4 years, 107 patients had an adverse cardiac event, with an overall events rate of 13.2/year. Cox proportional hazards model was used with New York Heart Association functional class, LV ejection fraction, right ventricular function, indexed left atrial volume, E/e' ratio, and the statistical interaction term between E/e' ratio and LV ejection fraction. The effect of E/e' ratio on mortality depended on the degree of LV systolic dysfunction. An increasing E/e' ratio was a strong predictor of outcome in patients with mild to moderate LV dysfunction but was inversely associated with mortality in patients with severe systolic dysfunction.


CONCLUSIONS
This study demonstrated the role of the interaction between LV ejection fraction and E/e' ratio in predicting prognosis in Chagas cardiomyopathy patients. The E/e' ratio had a stronger prognostic value in patients with mild and moderate LV dysfunction and was inversely associated with mortality in patients with advanced systolic heart failure.
School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Maria Pereira
MP
Nunes
Enrico Antônio
EA
Colosimo
Rodrigo Citton Padilha
RC
Reis
Marcia M
MM
Barbosa
José Luiz Padilha
JL
da Silva
Felipe
F
Barbosa
Fernando Antônio
FA
Botoni
Antônio Luiz
AL
Ribeiro
Manoel Otávio
MO
Rocha
D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D002598:Chagas Cardiomyopathy / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D015897:Comorbidity; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology