title: Prognostic implications of tissue Doppler imaging-derived e/ea ratio in acute heart failure patients.
abstract: BACKGROUND
  Tissue Doppler-derived transmitral to mitral annular early diastolic velocity ratio (E/Ea), as a noninvasive estimation of left ventricular (LV) filling pressures, is a strong prognosticator in various cardiac scenarios including chronic heart failure; nevertheless, its utility for risk stratification in the whole spectrum of acute heart failure (AHF) patients remains elusive. Thus, the aim of this study was to determine the association between E/Ea ratio and 1-year mortality in nonselected patients with AHF.
  
  
  METHODS
  The study included 417 consecutive patients admitted for AHF. Twenty-two patients were excluded due to nonaccurate Ea measurements, leaving the final sample to be 395 patients. E-wave, septal, and lateral Ea velocities were measured following initial stabilization and according to current recommendations. The association of mean E/Ea ratio with all-cause mortality was assessed using Cox regression analysis.
  
  
  RESULTS
  At a median follow-up of 306 days (interquartile range, 118-564), 89 deaths (22.5%) were registered. Mean age and E/Ea ratio were 72 ± 11.5 and 20 ± 3. Proportion of LV ejection fraction ≥50% was 47%. In multivariate analysis, after adjusting for well-known prognostic factors, including natriuretic peptides, E/Ea ratio was linearly associated with an increase risk of all-cause mortality (HR 1.04, 95% CI 1.03-1.05; P < 0.001, per increase in one unit of E/Ea). The threshold of risk was identified above 20. No significant interactions among the most important subgroups were found.
  
  
  CONCLUSIONS
  In AHF patients, tissue Doppler imaging derived E/Ea ratio is independently associated with an increased risk of all-cause mortality.
authors.affiliation: Cardiology Department, Clinical University Hospital, INCLIVA, University of Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Blas
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: David
authors.initials: D
authors.lastname: Escribano
authors.forename: Jaime
authors.initials: J
authors.lastname: Muñoz
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
mesh_terms: D000208:Acute Disease; D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D012306:Risk; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: E/Ea ratio; acute heart failure; prognosis; tissue Doppler