title: The prognostic value of a new tissue Doppler parameter in patients with heart failure.
abstract: It has been shown a good accuracy to predict high left ventricular end-diastolic pressure for a value >1.6 of a new tissue Doppler index, E/(E' × S'), including the ratio between early diastolic transmitral and mitral annulus velocity (E/E'), and the systolic mitral annulus velocity (S'). Our aim was to evaluate the prognostic value of E/(E' × S') > 1.6 in patients with heart failure (HF). Echocardiography was performed in 345 consecutive hospitalized patients with HF, in sinus rhythm, at hospital discharge and after 1 month. Worsening of E/(E' × S') was defined as any increase of baseline value. The primary end point consisted of cardiac death or readmission due to HF worsening in long term follow-up. At discharge, 153 patients (44.3%) presented E/(E' × S') ≤ 1.6 (group I) while 192 patients (55.7%) presented E/(E' × S') > 1.6 (group II). During the follow-up period (35.1 ± 8.7 months) the first cardiac event was cardiac death in 11 patients (3.1%) and readmission for HF in 179 patients (51.9%). The composite end point was significantly higher in group II than in group I (163 events, 84.9 % vs. 27 events, 17.6%, p < 0.001). By multivariate Cox regression analysis, E/(E' × S') > 1.6 was the best independent predictor of cardiac events (hazard ratio = 4.46, 95% CI = 2.44-8.13, p = 0.001). Patients with E/(E' × S') > 1.6 at discharge and its worsening after 1 month have presented the worst prognosis (all p < 0.05). In patients with HF, E/(E' × S') > 1.6 at hospital discharge is a powerful predictor of clinical outcome particularly if it is associated with worsening.
authors.affiliation: Cardiology Clinic, "Victor Babeş" University of Medicine and Pharmacy, G.Adam 13A, Timişoara, Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Mornoş
authors.forename: Lucian
authors.initials: L
authors.lastname: Petrescu
authors.forename: Adina
authors.initials: A
authors.lastname: Ionac
authors.forename: Dragoş
authors.initials: D
authors.lastname: Cozma
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
references.citation: Heart. 2009 Jul;95(14):1172-8
references.pmid: 19359264
references.citation: J Am Coll Cardiol. 2003 Mar 5;41(5):820-6
references.pmid: 12628728
references.citation: Circulation. 2002 Mar 19;105(11):1387-93
references.pmid: 11901053
references.citation: Int J Cardiol. 2009 Aug 14;136(2):120-9
references.pmid: 18635276
references.citation: Am Heart J. 2008 Dec;156(6):1056-64
references.pmid: 19032999
references.citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references.pmid: 16376782
references.citation: J Am Soc Echocardiogr. 2002 Feb;15(2):167-84
references.pmid: 11836492
references.citation: Eur J Heart Fail. 2004 Mar 15;6(3):335-41
references.pmid: 14987585
references.citation: Eur J Echocardiogr. 2008 Sep;9(5):594-8
references.pmid: 18296408
references.citation: J Am Soc Echocardiogr. 2006 May;19(5):522-8
references.pmid: 16644435
references.citation: Eur Heart J. 2007 Oct;28(20):2539-50
references.pmid: 17428822
references.citation: J Am Coll Cardiol. 2005 Apr 19;45(8):1223-6
references.pmid: 15837253
references.citation: Am J Cardiol. 2007 Sep 1;100(5):870-5
references.pmid: 17719336
references.citation: Heart. 2006 Jun;92(6):775-9
references.pmid: 16251233
references.citation: Am J Cardiol. 1997 Apr 1;79(7):921-8
references.pmid: 9104907
references.citation: J Am Soc Echocardiogr. 2003 Jul;16(7):777-802
references.pmid: 12835667
references.citation: J Cardiol. 1995 Dec;26(6):357-66
references.pmid: 8558414
references.citation: Am J Cardiol. 2008 Sep 15;102(6):722-5
references.pmid: 18773996
references.citation: J Am Coll Cardiol. 2007 May 15;49(19):1903-14
references.pmid: 17498573
references.citation: Lancet. 2009 Apr 18;373(9672):1382-94
references.pmid: 19356795
references.citation: Am J Cardiol. 2005 Apr 1;95(7):892-5
references.pmid: 15781027
references.citation: J Am Soc Echocardiogr. 2009 Feb;22(2):107-33
references.pmid: 19187853
references.citation: J Am Coll Cardiol. 1997 Nov 15;30(6):1527-33
references.pmid: 9362412
references.citation: Acta Cardiol. 2009 Apr;64(2):213-8
references.pmid: 19476114
references.citation: Eur J Heart Fail. 2005 Aug;7(5):820-8
references.pmid: 15921957
references.citation: J Am Soc Echocardiogr. 2003 Apr;16(4):333-9
references.pmid: 12712015
references.citation: Int J Cardiovasc Imaging. 2008 Apr;24(4):399-407
references.pmid: 17972161
references.citation: Am J Cardiol. 2009 May 1;103(9):1275-9
references.pmid: 19406271
references.citation: Circulation. 2000 Oct 10;102(15):1788-94
references.pmid: 11023933
references.citation: Eur Heart J. 2006 Apr;27(7):839-45
references.pmid: 16510467
references.citation: Circulation. 2006 Aug 1;114(5):438-44
references.pmid: 16880341
references.citation: Am J Cardiol. 2008 Aug 15;102(4):463-8
references.pmid: 18678307
references.citation: Int J Cardiol. 2005 Aug 18;103(2):175-81
references.pmid: 16080977