title: Prognostic value of septal E/(E'×S') ratio in predicting cardiac death in patients with heart failure.
abstract: BACKGROUND
  A new tissue Doppler index, E/(E'×S'), including the early diastolic transmitral/mitral annular velocity (E/E') ratio and systolic mitral annular velocity (S'), has a good accuracy in predicting left ventricular filling pressure.
  
  
  OBJECTIVE
  To investigate the value of E/(E'×S') measured at different sites of the mitral annulus to predict cardiac death in patientswith heart failure (HF).
  
  
  METHODS
  Echocardiography was performed in 342 consecutive hospitalised patients with HF, in sinus rhythm, at hospital discharge and after one month. Velocities were determined at septal and lateral mitral annular sites, and average values obtained. E/(E'×S') worsening was defined as a value greater than the value determined at discharge. The end point was cardiac death.
  
  
  RESULTS
  During the follow-up period (35 ± 8.8 months), cardiac death occurred in 52 (15.2%) patients. Septal E/(E'×S') at hospital discharge presented the largest area under receiver operating characteristic (ROC) curve to predict cardiac death (0.85,95% CI 0.79-0.90, p < 0.001). A statistical comparison of the ROC curves demonstrated no significant differences between septal and average E/(E'×S') (p = 0.54), but the accuracy of septal E/(E'×S') was better compared to the other analysed echocardiographic parameters [E/(E'×S'), E/E', S', etc., all p < 0.05]. The optimal septal E/(E'×S') cut-off was 3.03 (75% sensitivity,83% specificity). Before discharge, 96 (28.1%) patients presented septal E/(E'×S') > 3.03. Cardiac death was significantly higher in patients with E/(E'×S') > 3.03 (39 deaths, 40.2% vs. 13 deaths, 5.3%, p < 0.001). Patients with septal E/(E'×S') > 3.03 at discharge and worsening after one month presented the worst prognosis in the overall population.
  
  
  CONCLUSIONS
  Septal E/(E'×S') is a powerful predictor of cardiac death in patients with HF.
authors.forename: Cristian
authors.initials: C
authors.lastname: Mornos
authors.affiliation: 'Victor Babeş' University of Medicine and Pharmacy, Timisoara, Romania. drpetresculucian@gmail.com.
authors.forename: Lucian
authors.initials: L
authors.lastname: Petrescu
authors.forename: Sorin
authors.initials: S
authors.lastname: Pescariu
authors.forename: Rodica
authors.initials: R
authors.lastname: Dan
authors.forename: Dragos
authors.initials: D
authors.lastname: Cozma
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*